The Forum

Does the increase in chronic disease prevalence really reflect poorer health?

Petra Esseling

There’s an overall consensus among health care leaders that the increasing prevalence and cost of treatment for chronic diseases is the biggest challenge facing health care systems in the developed world. But is it really?

A group of Canadian health care researchers doesn’t think so. The team suggests that the current rise in chronic disease cases has been inflated and that the actual predictions are not as alarming as some have said.

According to the researchers’ article in the British Journal of Medicine, the increase in chronic disease is a result of better testing, more incentives to diagnose chronic disease, and lower diagnostic thresholds, rather than an actual increase in prevalence. So, we are defining people as “sick” today who would not have been considered sick in the past. Similar claims have been made by others about patients on the autism spectrum or patients with food allergies, among others.

So have we got it all wrong? We don’t think so.

In many ways, we would be happy to think that the burden of chronic disease will not increase in the future. But in the end, the argument that the Canadian researchers have made is irrelevant to our strategy for sustainability and the need for health care transformation.

It doesn’t matter why the number of chronically-ill patients is rising or how they are being identified—patients are at our front door and we have to change our system to meet their needs.

Better testing and lower thresholds for diagnoses have resulted in the identification of chronically-ill patients who would have not been diagnosed or treated in the past. That’s a good thing. Even just a few decades ago, these patients may have lived a lower quality of life with higher rates of mortality.

Consider a COPD patient who would have been disabled or would have suffered a heart attack in the past because her respiratory symptoms weren’t identified and treated. Nowadays, this patient’s COPD is identified, her disease is managed, and her health is improved.

Today, we have a more accurate count of chronic illness and those in need of support for their conditions than we did in the past. While we certainly have to be careful to avoid unnecessary treatment, we see this as an improved prevalence rating rather than an inflated one.

The lifestyle epidemic

As we see more patients suffering from multiple chronic diseases and requiring significant care, what needs to change?