Chronic diseases are the main cause of death in both rich and poor countries; hence fighting chronic diseases has become a public health priority all over the world. An increasing number of investments are thus being made in the prevention and control of chronic diseases to reduce risk factors at the individual level and to eliminate the cause. In Italy, however, there is very little prevention and treatment being offered.
An invisible epidemic
The World Health Organization (WHO) has defined chronic diseases as an “invisible epidemic” responsible for 40 million deaths per year, which is nearly 70% of all deaths. The number one cause of death each year is cardiovascular disease (17.7 million). The Italian Association of Hospital Cardiologists (ANMCO) affirms that 240,000 people (110,000 men and 130,000 women) die each year of cardiovascular disease in Italy, which comprises 44% of all national deaths. The second leading cause of death worldwide is cancer (8.8 million), followed by respiratory diseases (3.9 million) and then diabetes (1.6 million). Chronic diseases include a vast group of diseases including heart disease, strokes, cancer, diabetes and chronic respiratory diseases. Other chronic conditions include mental diseases, musculoskeletal disorders, gastrointestinal disorders, visual and hearing impairment and genetic diseases.
In addition to having a high fatality rate, chronic diseases can also create disabling conditions. The impact of disease on a person’s health can be quantified and measured in terms of DALYs (Disability-Adjusted Life Year), or rather, years of healthy life lost due to disability.
The main causes
Common modifiable risk factors lie at the base of all major chronic diseases, such as an unhealthy diet, use of tobacco, excessive quantities of alcohol and lack of physical activity. These causes also generate ‘intermediate risk factors’ which include high blood pressure, high blood sugar, high cholesterol levels and obesity. Other risk factors are not modifiable, such as age and genetic predisposition. Chronic diseases, however, are also linked to implicit determinants that are often defined as “causes of the causes” and which reflect major forces driving social, economic and cultural change such as globalization, urbanization, population ageing, environment policies and poverty. Given this data, it is incredible that 87% of all deaths occur in low-middle income countries. Implicit determinants are thus fundamental elements that must be considered for prevention.
Efforts made by the World Health Organization
“Progress Monitor – 2017”, the WHO report that monitors the developments and results of individual countries in their efforts to fight chronic diseases, is now online. The report provides data on the 19 progress indicators for each of WHO’s 194 Member States. Much progress has been made since 2015. Ninety-three countries have set national targets to fight chronic diseases (compared to 59 in 2015); 90 countries have set guidelines to manage the 4 major chronic diseases (compared to 50 in 2015); 100 countries have carried out physical activity awareness campaigns. Only 6 countries (5 from Africa) did not achieve any of the progress indicators (compared to 14 in 2015). The data from the report also confirms the importance of promoting a healthy lifestyle in preventing and fighting chronic diseases. Everyone can greatly reduce the risk of developing these diseases simply by adopting healthy habits, especially by not smoking, eating right, limiting alcohol consumption and exercising on a regular basis.
Italy is still waiting…
Not only is little being done in Italy to prevent chronic diseases, but even less is being done for chronic patients. The XV National Report on policies for the chronically ill entitled “Chronic Waiting” (In cronica attesa) – issued by Cittadinanzattiva’s (Active Citizenship non-profit organization) National Associations of Chronic Patients Coordinating Committee – gives a clear picture of the country’s bleak reality. Anyone suffering from a chronic disease in Italy enters into a time bubble of long waiting periods and delays in medical visits, diagnoses and check-ups. The whole system then accelerates too quickly at the time of medical visits, assistance, rehabilitation or consultations with specialists. There is no need to stress the obvious negative influence of this “time accordion” on the course of the disease and the patient’s adherence to treatment. This information is quite alarming considering the National Institute for Statistics (ISTAT) in Italy estimates that 39.1% of the population suffers from chronic diseases.
Improving disease course: Patient Support Programs
In hopes that prevention becomes more effective in reducing the dramatic number of chronic patients, the millions that are already ill need to be taken care of Patient Support Programs have become an effective resource in improving disease course and aim at improving a patient’s state of health and adherence to treatment, providing services such as home assistance, administration of medicine at home or at hospitals, 24-hour phone and online support for any type of problem, even psychological. Domedica has been developing customised Patient Support Programs for over ten years, putting the patient at the center in order to guarantee high-quality and effective care and increased adherence to long-term treatments.
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