The biggest risk to human life today is not infection but largely preventable illnesses. Health policy must shift from hospital-based treatment to early intervention, and the Treasury needs to take note
Prevention, they say, is better than cure. And for a long time, preventative health has been high up government agendas across the world. Most policy makers recognise that investing in prevention makes long-term economic sense.
However, political rhetoric is one thing. In times of fiscal austerity and – in the UK – major health service upheaval, preventative health risks being shunted to the bottom of the pile. This would not only be short-sighted. It would potentially add to the burgeoning health bill we collectively face.
World health trends are changing fast. Since the 1950s, living standards have risen, life expectancy has increased, and child mortality has fallen. Rapid globalisation, increased urbanisation and technological advances have broadened horizons – recasting what we as humans expect and demand.
In 2012, the principal cause of death is no longer infection. It is the group of illnesses defined as non-communicable diseases – the ones that are not transmissible from one human to another – that now present the greatest threat to human life.
The big four NCDs are cardiovascular disease, common cancers, diabetes and chronic obstructive pulmonary disease. None of these is a new disease. What is new is the scale of the problem, and the dawning realisation that traditional approaches to health care are becoming increasingly ineffective.
NCDs were once regarded as diseases of affluence, largely confined to high-income countries. But this view has rapidly shifted. Regardless of country or socioeconomic status, everyone is potentially at risk. Of the 57 million deaths across the world in 2008, 36 million (63%) were caused by an NCD. Of these, 48% were due to cardiovascular disease, 21% to common cancers, 12% to chronic obstructive pulmonary disease and 4% to diabetes. Globally, hypertension (high blood pressure) accounts for approximately 13% of deaths.
By 2030, non-communicable diseases will be killing 52 million people per year. The number of deaths is now so high, it is regarded as a pandemic.
Economically, the figures are just as startling. Harvard University’s School of Public Health has estimated that over the course of the next two decades, the cumulative economic loss resulting from NCDs (the big four plus mental health) will be US$47 trillion (£29trn). This equates to 75% of global gross domestic product in 2010 (US$63trn or £39trn).
So what are the causes? The scientific evidence is clear: if you smoke, have a poor diet, exercise little and drink alcohol excessively then you are at substantial risk of acquiring an NCD. Some commentators view rapid globalisation and urbanisation as causes. But this needs to be put into context.
The economic benefits of a global world are not in doubt; it is poor long-term planning that creates the problems. For health policy makers, the causes of and solutions to this pandemic present a fundamental challenge that requires subtle approaches – both for policy formulation and, in high-income countries such as the UK, the design of health care systems.
It is wrong to assume, for example, that the steep rise in NCDs stems from increased life expectancy. If you live to be 100, you might well die from an NCD-related illness, but greater longevity – one of medicine’s great success stories – is not in itself the cause. The problem lies with a lack of effective preventative interventions, and with people ‘discounting’ future problems by believing they are many years away.
In fact, almost a fourth of all global NCD-related deaths now occur before the age of 60. For example, evidence is emerging of rising bowel cancer rates among young people, which can be attributed in part to sedentary lifestyles and binge drinking.
This suggests that the way we think about health in the UK needs to change radically. Current health systems are not well adapted to dealing with a world where NCDs account for most of the burden of disease. These systems were developed at a time when infection was the main risk. They provide episodic, disjointed and hospital-based care.
A few simple interventions could potentially prevent, detect or mitigate debilitating diseases. Technology, for example – through phone apps and suchlike – could be used to help people monitor simple conditions. That alone is clearly not enough; once a problem is detected, it needs to be acted upon.
That is why tackling these long-term problems in the UK can no longer be regarded solely as an NHS issue. It is one that can be solved only by taking a whole-of-society approach. All sectors – government, employers, the private sector, non-governmental organisations and, most importantly, individuals – need to be involved in curbing the rise of what are, in many cases, preventable illnesses.
These issues were the focus of the Global Health Policy Summit recently held by the Institute of Global Health Innovation. One conclusion was clear: at the governmental level, tackling NCDs is as much an issue for the Treasury as it is for the Department of Health.
This is a long-term problem, and requires a new approach. It presents a fundamental challenge to health policy thinking in the UK but it is one the country cannot ignore.
Lord Darzi and Christopher Exeter are respectively director and senior fellow of the Institute of Global Health Innovation at Imperial College London. Lord Darzi is a former health minister under Labour and headed its NHS Next Stage Review. This article is based on research available at www.globalhealthpolicyforum.org/docs/GHPS_NCD_Report.pdf
