RESTRUCTURING
The changing nature of disease We have touched on the changing disease burden as a major global driver of change for the healthcare estate. At a United Nations meeting in September 2011 it was noted that the rise in NCD threatens the sustainability of healthcare systems in high-income countries, as well as the expansion of healthcare systems in low and middle income countries. NCD’s such as cardiovascular disease (CVD), diabetes, chronic obstructive pulmonary disease (COPD) and common cancers can often be lifestyle diseases attributed to tobacco, poor diet, physical inactivity and the harmful use of alcohol. This, of course, begs another
question – why do we as a society do things to our bodies that creates significant long-term harm? Are we just weak in the face of temptation? Are we given sufficient information about the risks involved? Are we the victims of peer pressure? Does the DNA of some have an inherent susceptibility? Are we drawn in by slick modern marketing? Government intervention was successfully implemented with the smoking ban in many countries and perhaps now we need the same approach with the price and availability of alcohol and clearer guidance on diets, particularly relating to the balance of macro nutrients (fats, proteins and carbohyrdrates). What we do know is that the rise of NCD
is going to move the goalposts in terms of the facilities we need to deliver healthcare in the years and decades to come. A study by the Harvard School of Public Health calculated that the costs of NCD plus mental health problems will total some $47 trillion over the next 25 years – about 75% of current global GDP!
Given the sheer scale of the challenge,
there is widespread agreement that our current healthcare systems are not going to adapt easily to changing needs. We currently have systems that are by nature episodic, disjointed and acute hospital based. That means we have to think closely about the healthcare estates we will need as the manner of treatment shifts as shown in Table 2.
The ageing population Exacerbating the rise of so-called ‘lifestyle diseases’ is the impact of demographics. Global life expectancy at birth rose from 47 to more than 67 between 1950 and 2012.
Figure 1: Healthcare drivers of change.
It is expected to reach 75 in 2050 as deaths become more concentrated in older age. At the same time, deaths from heart attack and stroke have been declining for more than 50 years and the screening practices for a number life threatening diseases have also improved. The result is that in 2012 we have 800
million people over the age of 60 or around 11% of the world’s population. By 2030 that number is forecast to be 1.4 billion, or 17%, and 2.0 billion by 2050 or 22%. Indeed, based on current trends, for the first time in history a higher proportion of people in the world will be aged 60 and over (21.0%) by 2047 than are aged under 15 (20.8%). The increase in life expectancy and
declining fertility has some profound implications for society. For example, the increase in older people will drive a sharp decline in the support ratio i.e. the ratio of people of working age (15-64) versus those aged 65 or over. At the same time, those living longer are
very unlikely to live free of illness. So, the incidence of chronic illness will be more prevalent in the elderly. Also people with a chronic condition usually have more than one (multi-morbidity). For example, 50% of over 65s have two or more chronic conditions and 50% of over 75s have three or more chronic conditions, such is the complexity of multi-morbidity. This means that the challenges ahead become even more complex and more expensive. As we live longer our chances of suffering from dementia increases. Indeed, with varying
‘The changing disease burden will involve a radical shift in the approach to population screening, treatment, medication and monitoring with the inevitable changes to the healthcare estate of scale, acuity and distribution.’
IFHE DIGEST 2013
levels of acuity it may even become inevitable for most people as they grow older. Worldwide, 35.6 million people live with dementia today and the numbers are set to double every 20 years. The projections are 65.7 million in 2030 and 115.4 million in 2050. Alzheimer’s disease will also have a significant impact on the UK economy in the next 40 years. The projected increase in those suffering from Alzheimer’s is forecast to rise from the current 700,000 to 1.7 million, while the care period for Alzheimer’s sufferers runs from between 7 and 20 years. In short, we must recognise that there is a
great deal to be done as we map out the long- term relationship between increasing length and the associated quality of life.
Patients of the future The good news is that we are at least making a start. Patient-centric or patient-centred healthcare are the new buzz phrases. This approach allows clinical planners and designers of new models of care to focus on what is important. This is an essential first step, but we must be aware that patients come in many forms, both physically and emotionally. For example, healthcare systems will soon be welcoming the first digital generation as a bulk patient group. They will have grown up on a diet of privacy and digital communications. They will be adept at searching the digital world for a diagnosis for their healthcare problems and engage with digital self help communities. They will possibly be as informed of the diagnostic and treatment options as the doctors they visit. After all, the patient may have had two weeks to research their particular problem whereas a doctor in a primary care setting will typically have 10 minutes or less to make a diagnosis and set a course of treatment. That poses some interesting questions for patient/doctor relationships. However, in general, greater access to digital medical intelligence has to be welcomed. If individuals are going to be expected to take
15
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84