The U.S. medical system is focused on responding to acute, rather than chronic, illnesses. This is despite the fact that 130 million Americans have one or more chronic conditions — and these Americans are associated with 85 percent of all medical care expenditures. In the Medicare program, two-thirds of all spending is for beneficiaries with five or more chronic conditions.
Fortunately, noncommunicable, chronic diseases are beginning to get the visibility that is commensurate with their burden and economic impact.
On May 13, the United Nations announced a gathering of heads of state in September 2011 to discuss the prevention and treatment of noncommunicable, chronic diseases. In the coming year, there will be a series of meetings at the ministerial level to discuss the "rising incidence and socio-economic impact of the high prevalence of noncommunicable diseases worldwide … with a particular focus on the developmental challenges faced by developing countries."
Many chronic conditions are preventable. Obesity, for example, is a major cause of chronic disease in many countries, and First Lady Michelle Obama's leadership in this issue is a sign of how important the prevention of chronic diseases has become. Other chronic conditions are treatable at relatively low cost.
Chronic diseases such as heart disease, certain types of cancers, respiratory diseases, diabetes, mental illness and injuries can no longer be seen simply as problems faced by higher-income countries. Surprisingly, chronic diseases are now responsible for the greatest burden of disease in many low- and middle-income countries, where 80 percent of the deaths from chronic disease in the world occur.
The U.N. announcement is an acknowledgement of the important role chronic diseases are playing in low- and middle-income countries. In low-income countries, like Bangladesh, almost half of the burden of disease is attributable to chronic diseases. In Latin America and the Caribbean, chronic diseases represent over half of the burden of disease in most countries. These diseases are also having a significant social and economic impact on the economies of many countries. Nations such as Russia, China and India are forecast to lose hundreds of billions of dollars in productivity due to chronic diseases.
The focus should be on prevention. In recent years, high-income countries have initiated a series of effective interventions to control smoking, improve diet and exercise, reduce obesity and reduce alcohol abuse. Low- and middle-income countries are beginning to see the same risk factors, leading to a growing prevalence of chronic diseases. They are clamoring for help, and it is time for the global community to develop similar programs.
Although many preventive activities are inexpensive and cost effective, it will take the efforts of the heads of state in the countries and the international aid agencies to increase awareness of the benefits of prevention and provide some of the resources that will be needed. Brazil, for example, with assistance from the World Bank, has demonstrated the cost-effectiveness of reengineering its parks and making exercise equipment available in schools and community centers.
There are also many examples of countries successfully screening people for hypertension, cancer and diabetes and then finding cost-effective means of treatment. Other programs are designed to keep people taking their medicines by creating self-help groups. In Mexico, for example, there are contests among the self-help groups that spur individuals to even greater compliance.
Over the next several years, the leadership to combat chronic disease will need to come from heads of state and international aid agencies. The prevention and management of chronic diseases is not simply the purview of national health departments but requires the commitment and collaboration of many different government agencies in nations across the globe, including departments of agriculture, labor, finance, education, transportation and housing. It also requires the involvement of the international agencies that so far have focused mainly on infectious diseases. Finally, it requires the engagement of the private sector and the people themselves.
The top public health issue of the 21st century is likely to be the prevention and treatment of chronic diseases. Heads of state will be taking an important first step in addressing this issue next year. In order to be a successful meeting, there must first be a dialogue that gets everyone involved. The time to start that conversation is now.
Sir George Alleyne is former head of the Pan American Health Organization. Gerard Anderson (firstname.lastname@example.org) is director of the Johns Hopkins Center for Hospital Finance and Management. Michael Klag is dean of the Johns Hopkins Bloomberg School of Public Health. All are professors at Johns Hopkins.