Chronic Disease Prevention: Challenge of Societal ProportionsBy Jan Hogewoning | Wed, 01/27/2021 - 14:50
At this year’s Mexico Health Summit, David Kershenobich, Director General of the National Institute of Medical Sciences and Nutrition Salvador Zubirán (INCMNSZ), called for a preventive approach to chronic non-transmissable diseases that embraces a holistic understanding of the causes and possible solutions.
On Wednesday, Jan. 27, Kershenobich began his presentation, titled ‘Importance of Prevention and Cost of Chronic Diseases’, explaining that, in reality, our understanding of health has evolved through millennia, impacted by social, cultural and historical processes. Nowadays, the predominant scope that is used to define disease is biomedical. However, to move toward prevention, we need to include individual and collective social processes that go beyond just science and technology, Kershenobich stated. Health must be understood not through the presence or absence of a disease, but a broader set of physical, mental and social factors. This is important, he noted, because we are increasingly aware and able to act on both genetic, epi-genetic and environmental factors leading to a disease.
Kershenobich pointed out that there are different types of prevention. Primary prevention, he stated, refers to lifestyle: diet, physical exercise, living environment and access to health services. Secondary prevention starts when a person is already ill but actions can be taken to prevent complications related to that disease. Finally, there is tertiary prevention, which is when a person already has complications but steps are taken to prevent them from worsening. “Considering that we have different levels of prevention, we require an approach that includes actors beyond medical professionals,” he said. This need is further strengthened by the fact that a chronic degenerative disease is generally a long-term condition, which means it is not just an immediate threat to health of an individual but also a significant factor in deciding quality of life and overall productivity.
Kershenobich highlighted the enormous cost of treating chronic degenerative diseases. The first example he mentioned is diabetes mellitus, where the average cost of treatment is MX$1,500 (US$74) a month. He pointed out that 85 percent of Mexican diabetes patients receive treatment. For renal insufficiency, the cost of treatment, which can include dialysis and medications, varies between MX$8,000 (US$394) and MX$15,000 (US$739) per month. Arterial hypertension, a condition that affects an estimated 31.5 percent of Mexicans, is estimated to cost between MX$1,000 (US$49) and MX$3,000 (US$148) a month. About 70 percent of Mexicans with hypertension are said to receive treatment in some way for this condition.
Given the high-cost burden and obvious impact on well-being at an individual and society level, what can we do to prevent chronic degenerative diseases and complications? Kershenobich presented a study published by Lancet, which addressed the impact of an integral care model to treat diabetes mellitus. Measures taken went beyond just administering insulin. Patients were educated on self-care, risk behaviors, their social environment and doctors were given tools to monitor and provide continuous feedback to patients. They were reminded to follow up on patients in the long term, driven by financial incentives. The result was that patients ended up having significantly less complications.
Kershenobich emphasized that the health system in Mexico needs to define ‘key concepts’ and ‘key indicators’ that can help homogenize care models around the country. This way, patients, and doctors, can move between different institutions. At the forefront, he stated, stands primary care. General practitioners need to have an active role in not just diagnosis and treatment but also educating patients and other doctors. Besides doctors, patients also have a responsibility to educate those around them, and realize that there are people in their lives who are at similar risk of developing chronic disease. Furthermore, Kerschenobich suggested that patients should be able to be attended by medical professionals from different specializations, in addition to nutritionists and sports coaches, in one single location.
Behind a more integral approach to chronic disease lies public policy. This process needs to be supported by far more data collection through studies, not just in the medical area but in other fields too. Kershenobich mentions economists, sociologists and urbanists as valid actors. The end goal, Kersenbobich said, is to create a movement. “A movement is the best way to create a society-wide commitment,” he stated.