With our healthcare systems strained by the simultaneous outbreaks of monkeypox, polio and COVID-19, chronic diseases are not getting the attention they deserve. However, as we continue to face ongoing threats from infectious diseases, we must build resilient health systems that are prepared for both public health emergencies and ongoing population health challenges.
Pre-pandemic chronic diseases were already a serious problem in the US. According to the Centers for Disease Control and Prevention (CDC), one in six adults has one chronic disease and four in ten 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 severely impacted chronic diseases, directly and indirectly through disruptions in prevention and disease management, and contributed 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 of serious illness from COVID. We’ve also witnessed the birth of a new chronic disease in “Long COVID,” which affects nearly one in five Americans.
A growing body of studies have shown that COVID can increase a person’s risk of diabetes even months after infection. A Lancet study found that people infected with COVID were about 40 percent more likely to develop diabetes than others in the control groups up to a year later. For every 1,000 people screened in each group, approximately 13 additional people in the COVID group were diagnosed with diabetes. Even people with mild infections and no prior risk factors for diabetes had an increased likelihood of developing the chronic condition.
Several studies have also highlighted how the pandemic has created a barrier to cancer screening. A 2021 study of the impact of the pandemic on cancer care in Louisiana and Georgia found that there were nearly 30,000 fewer reports of cancer pathology than in 2019, a 10 percent decrease. Many reported having postponed or missed check-up appointments in 2020 due to fears of contracting the virus.
Without responding to the dual crisis of infectious disease threats such as COVID and chronic diseases, each will continue to amplify the negative impact of the other. This will only further strain our healthcare systems and ultimately create barriers or reduce the capacity to care for other health problems.
Our healthcare system must align incentives to encourage payers, providers, employers, and individuals to better prevent, diagnose, treat, and manage chronic diseases before they become acute, costly problems. This starts with improving access and removing barriers to GPs and full integrated care.
Primary care physicians are crucial in helping patients prevent and manage chronic diseases and provide referrals to other specialists who can help with their conditions.
According to a survey by the Kaiser Family Foundation, a quarter of adults and almost half of adults under the age of 30 do not have a family doctor. This care inequality is worse for minorities. A 2020 African American Research Collection survey found that Black, Native American, and Hispanic Americans reported having less access to a family doctor than their White counterparts.
A positive impact of the pandemic has been the adoption of telemedicine, particularly for people in rural areas or healthcare “deserts”. New advances in technology may also expand the role that telemedicine plays in home care. Remote patient monitoring devices allow providers to remotely monitor the patient’s progress and receive notifications if an issue arises. To continue reaping the benefits of telemedicine, we need to make emergency permits permanent and ensure payment parity for providers. Equal access to the Internet for all Americans is also necessary to reduce inequalities in care.
Standardized, interoperable health 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 new technology tools such as big data analytics and genomic testing, providers can reach out early and more effectively track, monitor and manage patients at home while gaining a deeper understanding of how, why and where chronic diseases arise.
By investing in resilient health systems to deal with public health emergencies and chronic diseases, we can promote healthy longevity for all.
dr William Haseltine is President of ACCESS Health International and moderates two expert panels at the Metabesity 2022 Conference about how the lessons of the COVID-19 pandemic can prepare us to tackle the ongoing chronic disease epidemic.