Auteur: Helena Spongenberg
BRUSSELS - Chronic disease is the leading cause of mortality in Europe. Over one third of the European population above the age of 15 have a chronic disease and two out of three people reaching retirement age will have at least two chronic conditions, according to the World Health Organisation (WHO).
Furthermore, the number of cases of chronic illnesses are on the rise and with it the social and economic burden of the diseases.
A chronic disease generally progress slowly and is a long-lasting condition. Modern medicine can sometimes control them, but not cure them. Because they also cause disability, chronic conditions have a major impact on the expectancy of life lived in good health.
Chronic illnesses affects people all over the world and the number of deaths from chronic diseases has increased worldwide and in every region since the year 2000, and it is no longer mainly confined to an aging population.
In Europe, chronic illnesses are by far the leading cause of mortality representing 77 percent of all deaths,
“Chronic diseases undermine the quality of life of millions of Europeans, and present the biggest challenge to the EU [...] target of increasing the healthy life years of its citizens by two years, by 2020,” according to EuroHealthNet - an umbrella body for different organisations working for a healthier Europe. The target was set in the European Innovation Partnership on Active and Healthy Aging.
The four main kinds of chronic illnesses are cardiovascular diseases - like heart attacks and strokes; diabetes; chronic respiratory diseases - like chronic obstructive pulmonary disease (COPD) and asthma; and some types of cancers.
Medical improvements in the last century
As the 20th century showed a great success in reducing epidemic infectious diseases, it has led to a new focus on chronic diseases. While premature deaths from acute illness have become fewer, the predominance of diseases that builds up over time has steadily increased.
Chronic diseases are a product of multiple influences on health - there is no longer one reason responsible for the disease.
The most common risk factors causing chronic diseases are tobacco use, poor nutrition, lack of physical activity, harmful alcohol consumption, and genetic predispositions.
Social and environmental factors also play an important role in the development of chronic diseases. Furthermore, there is a clear inequality in the burden of the conditions and in the access to prevention and control.
What chronic diseases have in common is that they need a long-term and many-faceted response, organised by different health professionals and extended into social care.
As the cases of chronic illnesses increases, so grows the medical, social and economic burden. WHO research shows that the overall burden will be even larger in the future if nothing is done about the growth of chronic disease cases now.
Between 70 to 80 percent of health care budgets - an estimated 700 billion euros - per year are currently spent on chronic diseases in the European Union, according to the European Commission.
A remodelling of health care systems
Most health care today, however, is still structured around acute episodes. At the moment, 97 percent of health care costs are spent on treatment and only three percent on prevention, according to European Commission numbers.
So the economic implications of chronic diseases are serious.
According to the WHO, chronic conditions “depress wages, earnings, workforce participation and labour productivity, as well as increasing early retirement, high job turnover and disability. [...] As expenditure on chronic care rises across Europe, it takes up increasingly greater proportions of public and private budgets.“
With all the complexity in the matter of chronic diseases, experts recommend prevention and management across different policy sectors and at different health care levels.
Firstly, prevention is an important step both at the private level and policy level. We ought to take better care of ourselves healthwise. While people ought take better care of their health, governments can also legislate in areas that will have direct and indirect effects on chronic diseases.
One example is the introduction of smoking bans. Different studies have shown various improvements in the area of health, both for adults and for children. Another example is how tackling health inequalities, for example, would indirectly help improve the burden of chronic diseases as lower social groups are the ones most affected by chronic diseases.
Management of chronic disease management is equally important. Chronic illnesses are health conditions that require continuous health care management over a period of years or decades. This includes more focus on self-management by patients, formal education for health providers, the use of multi-disciplinary teams and health workers, and IT systems that facilitate the easy exchange of information.
Health care systems need to be redesigned to have a stronger focus on chronically ill patients, experts say.
Therefore, investing in chronic disease management might include a makeover of our health care systems from one that is essentially reactive to one that is proactive and focused on keeping a person as healthy as possible.