THE BLOG

Chronic Disease Is A Public Health Crisis

30/03/2017 13:40 BST | Updated 30/03/2017 13:40 BST
Yegor Aleyev via Getty Images

We may be living longer in The West, but not all of us are living well. In England, an estimated 15 million people suffer from chronic health issues, while across the Atlantic, 50% of Americans suffer from a chronic health problem and one in four has a chronic illness.

Chronic, or long term conditions, cannot be cured, but instead must be managed throughout a patient's life with a combination of treatments, including drugs and therapies. Risk factors for many chronic conditions, including diabetes, hypertension, and heart disease, can be exacerbated by lifestyle choices. The key is early intervention which can slow progression and improve a patient's quality of life. If left unchecked however, chronic illness can quickly become debilitating.

Treating these conditions is not cheap. The Centre for Disease Control and Prevention, headquartered near Atlanta, Georgia, estimate that 75% of healthcare spending in the US goes on treating chronic illness. That's over £1 trillion every year. In 2011, the Department of Health in the UK estimated that 70 percent of the primary and acute care budget in England goes toward managing long term conditions.

This burden is set to increase, with the UK and the US facing rapidly ageing populations. It is estimated that, by 2035, nearly a quarter (23%) of the UK population will be 65 or older. For the US this figure is 21.7% by 2040. We know that older people typically require more healthcare, making doctor shortages and chronic disease management even more important in the future.

So how do we address this? Well the old adage 'prevention is better than cure' is as true as it ever was - and that starts with education. We need to put wellness, prevention and public health at the centre of medical curricula.

At St George's University, we're doing just that. Our Master of Public Health programme is part of our medical school and we also run a combined degree in Medicine & Public Health.

We also need more medical students to train as general practitioners (known as primary-care doctors in the US). Spotting long-term conditions early can help contain or reduce the disease, helping people stay healthy for longer and, in the process, save the healthcare system money.

But GPs are in short supply. The Royal College of General Practitioners (RCGP) has estimated that England will need an additional 8,000 GPs by 2020, while the United States is already 16,000 short of the primary-care doctors it requires. As a result, tens of thousands of people are not receiving the preventive measures needed to combat long-term illness; this situation is only going to get worse.

Medical students, however, are opting for highly specialised careers, rather than GP courses and primary care. On average, almost a third (30%) of GP training places across the UK were unfilled following the first round of recruitment in 2014, rising to 65% in the worst effected areas.

Exacerbating the shortage of primary care doctors is their maldistribution. Put simply, doctors tend to want to practice in capital cities and urban centres, resulting in fewer doctors per capita for rural communities.

In the UK, physician density is greatest in London and lowest in the East, East Midlands and the rest of the South East. In the US, the average number of primary care doctors to 100,000 in urban populations is 53.3, compared to 39.8 in rural areas. That is to say, addressing the overall shortage of GPs will not solve the problem by itself. Policies must be put in place to ensure doctors end up practicing where they are needed, too. Financial incentives may be one solution. Encouraging medical schools to recruit from rural areas is another.

All of us have an interest in solving this problem. We are all getting older, and will increasingly need help from primary care and chronic disease management doctors. The longer we allow this problem to continue, the lower standard of care we can look forward to in our later lives.