CB [VM 1079] Chronic illness and disability (Updated Lecture)

Introduction

Overview of Chronic Illness and Disability

Chronic illness refers to long-lasting health conditions that often require ongoing medical attention and can substantially alter an individual's quality of life. The impact of chronic illnesses extends beyond the physical health of individuals to their mental, social, and economic well-being. It is essential for healthcare systems to effectively address chronic conditions, not only to improve patient outcomes but also to allocate resources efficiently and reduce healthcare costs in the long term.

Importance of Addressing Chronic Illness in Healthcare

Addressing chronic illness is crucial given its increasing prevalence worldwide. Chronic diseases dominate the causes of morbidity and mortality, affecting millions and leading to significant healthcare expenditures. Moreover, healthcare systems must shift from reactive to proactive management of chronic illnesses, focusing on prevention, education, and comprehensive care models.

Outline of Topics

• What is chronic illness?

• Why focus on chronic illness?

• The prevalence of chronic illness in Egypt

• Models of disability

• The disability movement

• Experiences of chronic illness and disability

What is a Chronic Illness?

Definition

A chronic illness is defined as a long-lasting health condition or disease that typically persists for three months or longer, requiring continuous medical care and lifestyle management.

Impact

Chronic illnesses can significantly affect various body systems and can lead to mobility issues, chronic pain, fatigue, and other debilitating symptoms. Common examples include:

• Arthritis: Affects joints, causing pain and stiffness.

• Asthma: A respiratory condition leading to difficulty in breathing.

• Cancer: A group of diseases involving abnormal cell growth that can spread throughout the body.

• COPD (Chronic Obstructive Pulmonary Disease): A progressive lung disease causing breathing difficulties.

• Diabetes: A metabolic disorder characterized by high blood sugar levels over a prolonged period.

• Viral diseases like HIV/AIDS: Infectious diseases that severely impact immune function.

Distinction

• Non-communicable diseases (NCDs): These are long-lasting conditions typically not caused by infectious agents, such as diabetes or heart disease.

• Terminal illness: Lifelong conditions that ultimately lead to death, requiring specialized care and end-of-life planning.

Why Focus on Chronic Illness?

Major Causes of Mortality

Chronic diseases are leading causes of death and disability globally, with significant projections indicating that NCDs would account for 73% of global mortality by 2020. This underscores the urgent need for effective preventive and management strategies.

Global Transition in Disease Patterns

1. Epidemiological Transition: This describes the shift from infectious diseases to NCDs, marking changing health challenges. Examples include the rise in heart disease and Type II diabetes.

2. Demographic Transition: Aging populations contribute to more cases of chronic illness as the risk of developing NCDs increases with age.

3. Environmental Changes: Pollutants and other environmental factors have been linked to higher rates of chronic diseases.

4. Nutrition Transition: The adoption of sedentary lifestyles and unhealthy diets, often referred to as the 'Western diet,' has escalated the rates of NCDs.

5. Migration Influence: Urbanization and lifestyle changes associated with moving from rural to urban areas can increase chronic disease risk due to lifestyle and dietary shifts.

Prevention Challenges

Existing strategies for preventing chronic diseases face numerous challenges, especially in developing countries where healthcare resources are limited. The complexity of prevention measures exacerbated by a multiplicity of risk factors adds another layer of difficulty to targeting effective interventions.

Prevalence of Chronic Diseases in Egypt

Major Behaviors Contributing to NCDs

Specific behaviors significantly contribute to NCD prevalence, including:

• Tobacco use: High smoking rates among the adult population.

• Physical inactivity: A sedentary lifestyle prevalent among various demographics.

• Unhealthy diets: Consumption of high-fat, high-sugar foods leading to obesity and other metabolic disorders.

• Harmful alcohol use: Alcohol consumption patterns contributing to health issues.

Key Statistics from the STEPS Survey (MOHP & WHO, 2017)

• 23% smoking prevalence, with considerable shisha usage among adolescents and adults.

• High obesity rates- an increasing public health concern.

• Approximately 75% of the population is inactive, exacerbating health risks.

• Diabetes prevalence stands at 16%, with hypertension impacting 30% of the population.

• The average salt intake is nearly double the recommended guidelines, leading to elevated risk of cardiovascular diseases.

Challenges to Healthcare Systems

Healthcare systems are experiencing increased demands due to the growing needs for chronic illness management. Key challenges include:

• Resource allocation: Ensuring adequate resources to manage diverse patient needs amid a shortage of healthcare professionals.

• Comorbidities: The focus of healthcare often on single diseases rather than the complexities of treating patients with multiple conditions.

• Sustainability issues: Long-term sustainability of health programs amid rising chronic disease prevalence is a pressing concern.

Costs of Treating Chronic Illnesses

Healthcare expenditures related to chronic illnesses represent a significant portion of national budgets, with 86% of $2.7 trillion spent on managing chronic conditions. These costs can be classified into:

• Direct medical expenses: Hospitalizations, medications, and routine care costs.

• Indirect costs: Decreased productivity due to illness affecting patient employability and work output.

• Lifestyle factors: Behavioral health choices, such as smoking, alcohol use, and obesity, further increase treatment costs.

Burden of Treatment Theory

The burden of treatment theory highlights the workload on patients due to their healthcare needs, which encompasses:

• Symptom experience: The ongoing management of chronic symptoms.

• Managing therapies: Adherence to complex treatment regimens.

• Self-monitoring: The necessity for patients to self-manage their conditions, often leading to additional burdens.

• Interactions with healthcare systems: Navigating the healthcare system can be cumbersome and time-consuming.

• Relationships with networks and providers: The importance of having supportive networks for effective management of chronic illnesses.

Experience of Chronic Illness

Living with chronic illness impacts various life aspects, leading to:

• Practical consequences: daily adjustments in routine and responsibilities.

• Symbolic consequences: altered self-perception and identity issues related to their illness.

• Resource management: The need for economic, social, and healthcare resources to navigate daily challenges.

• Family dynamics: Changes in family roles and relationships as family members adjust to caregiving responsibilities.

Biographical Disruption

Chronic illnesses often lead to identity crises requiring individuals to reframe their life narratives to incorporate their health changes, as highlighted by William's (1984) work. The profound sense of loss regarding their previous self-image is discussed by Charmaz (1987), emphasizing the psychological burden beyond just the physical health aspects.

Impairment, Disability, and Handicap

Definitions

1. Impairment: Refers to abnormalities in bodily structures and functions.

2. Disability: Encompasses the loss of or reduced capability to perform specific activities.

3. Handicap: Represents the social disadvantages and barriers resulting from impairments and disabilities, heavily influenced by environmental factors.

Interrelations

For instance, arthritis may cause physical impairments leading to disabilities (such as difficulty in mobility), which can in turn create social isolation (handicap).

Models of Disability

1. Medical Model: Focuses on the physical and physiological aspects of disability, typically striving for cures or management methods to facilitate normal functioning.

2. Social Model: Emphasizes the societal barriers that contribute to disability and advocates for political and social actions aimed at the inclusion of disabled individuals in all aspects of life.

3. International Classification of Functioning, Disability, and Health (ICF): Integrates both the medical and social models in a biopsychosocial framework, considering:

   • Body structures and functions

   • Activities

   • Participation

Disability Movement

The disability movement emphasizes self-advocacy, political activism for rights, and independent living. It prioritizes the needs defined by individuals living with disabilities rather than those imposed by experts, asserting the importance of personal agency.

Keys to Progress

Recognizing the critical role of public health programs in:

• Enhancing care quality

• Preventing diseases and their complications

• Developing effective health policies and programs that address disparities in health resource allocation and accessibility.

Public Health Programs to Decrease Chronic Illness Prevalence

Key initiatives include:

• Cancer detection and survivorship services.

• Diabetes prevention and management programs.

• Heart disease and stroke prevention initiatives through community engagement.

• Comprehensive community health programs addressing various health issues, including tobacco control, obesity, nutrition, and healthy aging.

Conclusion

Addressing chronic illness and disability in healthcare requires innovative and unbounded thinking from all stakeholders. It is imperative to create integrated and adaptable healthcare models that prioritize prevention, education, and support for individuals living with chronic health conditions.