Innovative care for chronic conditions: building blocks for action

Chronic illnesses are those which affect a patient on an ongoing basis over an extended period of time and require a level of health management. This includes conditions like diabetes, heart disease and now, in the era of antiretrovirals, HIV.

This report from the World Health Organization (WHO) states that health systems around the world must reorganise how they deliver healthcare if they are to respond effectively to the rising levels of chronic disease. It goes on to outline why the levels of these conditions are increasing and why health systems are structurally unable to deal with this.

Findings include the following:

• Chronic diseases will be the major cause of disability globally by 2020, and the most expensive cost facing health systems.
• The success of public health initiatives and in the treatment of communicable diseases has led to a rising population and extended life expectancy. As people live longer, they become more susceptible to chronic conditions and are living with them for longer periods.
• Rising levels of industrialisation and urbanisation in developing countries, the associated adoption of unhealthy lifestyles by greater numbers of people, and the global marketing of health risks such as tobacco smoking, are also important factors.
• Chronic diseases are strongly linked with poverty. They also bring an added burden and greater complexity to the health systems of those developing countries still tackling infectious and communicable diseases.
• Health systems have evolved around the treatment of acute infectious diseases and dealing with patients' urgent concerns. This means that they are currently unable to effectively deliver the type of ongoing health management required in the treatment of chronic conditions. This is particularly the case in primary care where the majority of patients in developing countries seek treatment.
• While the acute care model dominates in health systems, the increasing levels of chronic conditions will lead to escalating expenditure on healthcare but without delivering any major improvements in people’s health.

Recommendations include the following:

• Promote political consensus for creating change in health policy by including all stakeholders – political leaders, community leaders, representatives of patients and families – in the process
• Ensure that policy in other areas, such as education, employment and housing, is aligned with health policy
• Create a health system where the different elements of care, and of administration, are effectively integrated
• Use healthcare personnel more efficiently, for instance by training healthcare workers to deliver the non-medical aspects of managing chronic illness such as counselling
• Ensure that healthcare is focused on the patient, their family and their community. This is important because it is the patient themselves, with the support of their family and community, who is the key individual in managing their own illness
• Prioritise public health initiatives aimed at preventing chronic disease.