Addressing the challenges of chronic disease
Technology will play a big part in the transformation of healthcare management needed to curb spiralling costs as the numbers of people with long-term conditions rise, says David Coleiro.
The management of chronic disease is causing concern, and rightly so. In the US, over half of adults are living with chronic conditions, such as heart disease, stroke, cancer, diabetes, obesity and arthritis. In Australia last year 90% of all deaths could be attributed to chronic disease. Statistics also show that this trend will not abate, with a 57% increase predicted by 2020. Perhaps surprisingly, emerging markets will be the hardest hit, with 60% of the burden.
This increased prevalence of chronic disease is demanding that healthcare systems find innovative and improved solutions focused on prevention, mitigation of disability and reducing the use of resources, as well as better outcomes for disease management. A sustainable healthcare system cannot be created unless the spiralling cost of chronic disease can be brought under control. The ratio of healthcare spend to GDP is unsustainable for governmental budgets. The pensions industry, too, is facing crippling costs, with the previous formula used, of death minus 10 years, being thrown into question as life expectancy increases and people live much longer with often multiple long-term chronic conditions.
Healthcare entitlement
With budgets under pressure, public and political views on the entitlement to health services are shifting. In Germany, for example, access to healthcare is restricted for those entering the country through the asylum system, and the number of visits to a healthcare provider (HCP) in any year is limited for the wider population too. Early research suggests that this has led people to consider carefully when to seek medical intervention and when to self-manage their illness. But is this restriction discouraging people from presenting with early symptoms which could enable early intervention?
Federal legislation also has a role to play. Various countries have used taxation to reduce the number of smokers. Research from South Africa proved a direct correlation between the increase in smoking taxation and the reduction in tobacco consumption. These taxes were particularly effective in preventing tobacco use among the young and those most affected by price inflation.
Taxation has also been deployed to reduce levels of soft drink consumption, a key factor in the surge of diabetes. In Mexico, the introduction of a soda tax reduced sales of taxed drinks by 6% across the general population, and bottled water sales increased by 4%. The impact on the poorest Mexicans was the most significant, who bought 17% less sweetened soft drinks – an important finding since diabetes also hits this segment of the population disproportionately. In the UK, NHS England announced a plan to introduce a 20% levy on sugary drinks and foods in all hospital cafes by 2020 and this trend is likely to expand globally.
Public health and education is critical
Healthcare leaders agree that ‘public health’ cannot be boxed up separately from ‘health’.
The effects of public health spending can be measured. Various initiatives have helped to reduce dietary salt and cholesterol; sexually-transmitted diseases and unwanted pregnancies have been prevented effectively by targeted campaigns, and remember the impact of HIV/AIDS campaigns in the past. However, despite positive evidence, relatively little is spent on disease prevention currently.
Smoking, drinking too much alcohol, dietary neglect and failing to get enough exercise continue to hasten sickness and death, and it costs in high numbers. So how can we get the money allocated to disease prevention? Messaging is all-important. The MRSA bacterium was a huge media priority a decade ago and, when a campaign helped to win NHS funding, the issue was tackled successfully. Are we actively doing enough about chronic conditions or are we sleepwalking into a crisis?
Technology
Undoubtedly, technology will play a role in the management of chronic diseases in the future. In the UK, only 2% of interactions with the NHS take place online currently. However, that is about to change with the recent announcement that IBM, Philips, Hewlett Packard and Google's Verily unit are set to work with the NHS on a range of projects to help patients stay well and out of hospital.
For example, IBM is one of a number of partner companies setting up an 'intelligence centre' to help patients to live independently with long-term conditions, such as diabetes, mental health problems, respiratory disease and high blood pressure.
Roll-out of such programmes will give patients far greater control over their own care. In turn the healthcare system will develop to deliver holistic, life-time support across patients’ multiple conditions. Attention is turning to use of mobile as a platform for preventative and curative healthcare. Real-time monitoring and the entrance of global players to this market means that mHealth has the potential to make a real impact. It has shown promise in sub-Saharan Africa and India, in particular.
While the business model for preventative healthcare is yet to be fully defined, analysts see this as a means of saving $200 billion a year, just in treating chronic diseases across the OECD and BRIC countries. However, a number of barriers need to be removed first, focusing on the adoption of new ways of working across healthcare systems and the changing role of the GP.
Evidence
Evidence will help this shift. And it is coming fast. For example, the UK Department of Health’s Whole System Demonstrator Programme was set up to provide clear data to show what telehealth and telecare could achieve. It featured a randomised controlled trial of telehealth and telecare, with 3,030 patients with diabetes, heart failure or COPD in the telehealth element, and recorded a 14-20% reduction in hospitalisations and a 45% reduction in mortality rates.
There will also be a call to remove the perverse incentives which see staff incentivised by the number of people they treat, as opposed to their ability to heal.
Stemming the rise of chronic disease requires an approach to wellness and healthcare that works across all societies and which integrates primary, secondary and tertiary prevention and health promotion across all sectors. It will require system collaboration across the healthcare landscape to an unprecedented degree.
A tech-centric system will shift how healthcare is delivered and, in turn, affect the roles of patients and HCPs. Businesses and governments will also become more actively engaged in the wellbeing of employees and society. Collaboration and resource-sharing will increase and companies from disparate industries will work together to develop complete health support offers, including lifestyle coaching, health monitoring and medicines. These will be purchased or leased as a package.
Pharma needs to realign its own role to remain a key part of those partnerships. Such collaborations will help the industry to further improve the outcomes it can achieve with its products and enable greater targeting and personalisation of treatments. It will also need to support governmental agendas and include preventative, or even curative, intent. The sands are shifting and pharma needs to be central to those shifts.
About the author:
David Coleiro is a Director at Strategic North with over 20 years' experience in the strategic management and development of global brands.
Strategic North is a healthcare brand building agency that works with clients in the pharmaceutical industry around the globe to build the successful brands of today and tomorrow, grounded in human insight and scientific understanding.
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