We need resilient health systems to address the dual crisis of infectious and chronic diseases
With our health systems strained by the concurrent outbreaks of monkeypox, polio and COVID-19, chronic diseases are not receiving the attention they deserve. But as we continue to face ongoing infectious disease threats, we need to build resilient health systems that are equipped to face both public health emergencies and ongoing population health challenges.
Pre-pandemic, chronic disease was already a serious problem in the U.S. According to the Centers for Disease Control and Prevention (CDC), one in six adults has a chronic disease, and four in 10 adults have two or more chronic diseases. These include diabetes, heart disease, cancer, chronic lung disease, stroke and chronic kidney disease. Chronic diseases represent seven of the top 10 causes of death in the United States.
The COVID-19 pandemic has starkly affected chronic disease directly and indirectly through disruption to preventive care and disease management and by contributing to high morbidity and mortality rates. Heart disease, diabetes, cancer, chronic obstructive pulmonary disease, chronic kidney disease and obesity are all conditions that increase the risk for severe illness from COVID. We have also witnessed the birth of new chronic disease in “long COVID,” which affects nearly one in five Americans.
A growing number of studies has shown that COVID can increase a person’s risk of diabetes, even months after infection. A Lancet study found that people who were infected with COVID were about 40 percent more likely to develop diabetes up to a year later than others in the control groups. For every 1,000 people studied in each group, roughly 13 more individuals in the COVID group were diagnosed with diabetes. Even people who had mild infections and no previous risk factors for diabetes had increased odds of developing the chronic condition.
Several studies have also highlighted how the pandemic has created a barrier to preventive cancer care. A 2021 study published on the pandemic’s impact on cancer services in Louisiana and Georgia found there were nearly 30,000 fewer cancer pathology reports than in 2019, representing a 10 percent decline. Many reported delaying or missing preventive care appointments due to fear of exposure to the virus in 2020.
Without responding to the dual crisis of infectious disease threats like COVID and chronic disease, each will continue to amplify the negative effect of the other. This will only put further strain on our health systems, ultimately creating barriers or reduced care capacity for other health care issues.
Our health care system needs to align incentives to encourage payers, providers, employers and individuals to better prevent, detect, treat and manage chronic diseases before they become acute, costly problems. This begins with increasing access and removing barriers to primary care doctors and complete integrated preventive care.
Primary care doctors are critical to helping patients prevent and navigate chronic disease and providing referrals to other specialists who can assist with their conditions.
According to a Kaiser Family Foundation poll, one-fourth of adults and nearly half of adults under 30 don’t have a primary care doctor. This care disparity is worse for minorities. A 2020 poll by the African American Research Collection found that Black, Native and Latino Americans reported having less access to a primary care doctor than their white counterparts.
One positive impact of the pandemic has been the uptake of telemedicine, particularly for those in rural areas or health care “deserts.” New technological advances can also expand the role that telemedicine plays in at-home care delivery. Remote patient-monitoring devices allow providers to monitor patient progress remotely and receive alerts if there is an issue. To continue to reap the benefits of telemedicine, we need to make the emergency authorizations permanent and ensure payment parity for providers. Equitable access to the internet for all Americans is also necessary to reduce care disparities.
Standardized, interoperable health care data systems will also help providers reduce inefficiencies and improve the health system’s ability to proactively identify risk and coordinate care.
By investing in emerging technology tools such as big data analytics and genomic testing, providers can conduct early outreach and consistently follow-up, monitor and manage patients more effectively in their homes, while cultivating a deeper understanding of how, why and where chronic diseases develop.
By investing in resilient health systems to address public health emergencies and chronic disease, we can encourage healthy longevity for all.
Dr. William Haseltine is president of ACCESS Health International and will be moderating two expert panels at the Metabesity 2022 conference on how lessons from the COVID-19 pandemic can prepare us to address the ongoing epidemic of chronic diseases.