One of our biggest challenges: chronic disease

Health according to the WHO is the complete state of physical, mental and social wellbeing. Yet given that less than 5% of the world's population is totally free of disease one might legitimately argue that disease and not health is the norm and that only a tiny proportion of the world's population comes anywhere to meeting the WHO's definition of health.

In the case of most developed countries including Australia, the main culprit is chronic disease. In Australia today roughly around 90% of all deaths each year are from chronic disease.

Currently about half of all Australians suffer from one or more chronic diseases. Eight chronic diseases dominate our health scene – arthritis, asthma, back problems, cancer, chronic obstructive pulmonary disease, cardiovascular disease, diabetes and mental health conditions. About 40% of all Australians over the age of 45 have two or more of the ailments on this list and 8% of those aged over 65 currently suffer from four or more chronic diseases.

Patients suffering from chronic disease now account for most GP consultations and in many countries for at least 80% of all health costs. In the USA, for example, roughly half of all adults or 117 million people suffer from one of more chronic disease and 86% of all health spending was for such people.

Today roughly 22% or 3.7 million of all Australians suffer from cardiovascular disease, 2.3 million from asthma including 20% of all males aged 65-74, 3.3 million suffer from arthritis including 52% of all those aged over 75, about 500,000 currently have some form of cancer and at least 80% of all Australians will suffer from back pain at some stage of their life with 10% experiencing significant disability as a result.

With respect to cancer the risk of an individual being positively diagnosed by their 85^th birthday is 1 in 2 for males and 1 in 3 for females. Finally, 45% of all Australians will experience a mental disorder at some stage of their life with 20% experiencing a mental illness and 14% anxiety disorders. Overall it is a chilling scenario.

But what is a chronic disease? It is a degenerative disease that is long-lasting with persistent effects and one which can lead to disability or death. While many chronic diseases take some time to kill people there most enduring impact is to reduce the quality of life, restrict work and mobility, and considerably influence emotional health. In many ways chronic disease leads to an erosion of normal life.

What exactly is causing this explosion of chronic disease in countries like Australia?

The distribution of chronic disease in Australia reflects the complex interplay between ageing, longevity, health behaviour, socio-economic characteristics and environmental factors. There is little doubt that Australians are now living longer with many surviving into their eighties and beyond. In addition, three out of every five Australians are overweight or obese including 70% of all adult males and 56% of adult females.

There is also little doubt that human behaviour such as the lack of exercise or physical activity, poor nutrition, smoking or consuming too much alcohol are all important risk factors while those located on the fringe of our society are most at risk. Homeless people, for example, have smoking rates as high as 77%, indigenous Australians 50% and people suffering from mental illness 32%.

All this compares with the overall Australian smoking rate of around 13%. People living in rural and remote areas also have higher levels of chronic disease compared to urban dwellers. Within cities the socially disadvantaged suffer the most. Coronary heart disease, for example, has a death rate that is 40% higher among people living in the lowest socio-economic suburbs compared to more affluent suburbs as well as a lung cancer rate that is 1.6 times higher than people living in the highest socio-economic areas.

What is our current approach to controlling chronic disease and is it effective?

Largely our health system is primarily focussed on identifying disease and discovering treatments and cures rather than on disease prevention. Given this we must rethink our health care system and develop well planned, coordinated and strategic approaches designed to encourage healthy behaviour and healthy environments as well as provide assistance and support for people of every age and background.

To be effective the prevention of chronic disease must target the whole of an individual's life span and involve activities that encourage healthy living, early detection and appropriate management of existing diseases. In many ways this goes to the heart of the public health dilemma, ie should the government play a major role in managing such things or should responsibility rest with the individual?

On this the jury is still out but the fact remains that people are the wealth of Australia and it is not simply the number of people that is important but also their environment, skills, abilities and health status. People are without any doubt the critical human capital and the government has a basic responsibility to preserve, protect and bolster their environment, wellbeing and health.