Integrating prevention into health care
Due to public health successes, populations are ageing and increasingly, people are living with one or more chronic conditions for decades. This places new, long-term demands on health care systems. Not only are chronic conditions projected to be the leading cause of disability throughout the world by the year 2020; if not successfully prevented and managed, they will become the most expensive problems faced by our health care systems.
People with diabetes, for example, generate health care costs that are two to three times those without the condition, and in Latin America the costs of lost production due to diabetes are estimated to be five times the direct health care costs. In this respect, chronic conditions pose a threat to all countries from a health and economic standpoint.
Many costly and disabling conditions - cardiovascular diseases, cancer, diabetes and chronic respiratory diseases - are linked by common preventable risk factors.
- Tobacco use, prolonged, unhealthy nutrition, physical inactivity, and excessive alcohol use are major causes and risk factors for these conditions. Trends in tobacco use will increase in the foreseeable future especially in developing countries.
- The ongoing nutritional transition expressed through increased consumption of high fat and high salt food products will contribute to the rising burden of heart disease, stroke, obesity and diabetes.
- Changes in activity patterns as a consequence of the rise of motorised transport, sedentary leisure time activities such as television watching will lead to physical inactivity in all but the poorest populations.
Current systems of health care
Many diseases can be prevented, yet health care systems do not make the best use of their available resources to support this process. All too often, health care workers fail to seize patient interactions as opportunities to inform patients about health promotion and disease prevention strategies.
Most current health care systems are based on responding to acute problems, urgent needs of patients, and pressing concerns. Testing, diagnosing, relieving symptoms, and expecting a cure are hallmarks of contemporary health care. While these functions are appropriate for acute and episodic health problems, a notable disparity occurs when applying this model of care to the prevention and management of chronic conditions. Preventive health care is inherently different from health care for acute problems, and in this regard, current health care systems worldwide fall remarkably short.
How can health systems respond to this challenge?
Given that many conditions are preventable, every health care interaction should include prevention support. When patients are systematically provided with information and skills to reduce health risks, they are more likely to reduce substance use, to stop using tobacco products, to practice safe sex, to eat healthy foods, and to engage in physical activity.
These risk reducing behaviours can dramatically reduce the long-term burden and health care demands of chronic conditions. To promote prevention in health care, awareness raising is crucial to promote a change in thinking and to stimulate the commitment and action of patients and families, health care teams, communities, and policy-makers.
A collaborative management approach at the primary health care level with patients, their families and other health care actors is a must to effectively prevent many major contributors to the burden of disease.
Essential elements for action
- Support a paradigm shift towards integrated, preventive health care
- Promote financing systems and policies that support prevention in health care
- Equip patients with needed information, motivation, and skills in prevention and self-management
- Make prevention an element of every health care interaction
Many of the costly and disabling conditions facing health systems today can be prevented. Additionally, with proper support many of their complications can be averted or delayed.
Strategies for reducing onset and complications include early detection, increasing physical activity, reducing tobacco use, limiting prolonged, unhealthy nutrition.
Through innovation, health care systems can maximize their returns from scarce and seemingly non-existent resources by shifting towards activities that emphasize prevention and delay in complications. Small steps are as important as system overhaul. Those who initiate change, large or small, are experiencing benefits today and creating the foundation for success in the future.