Healthier People With More Disease

From Philly.com.

"Albert Einstein is reputed to have said that "everything should be made as simple as possible, but not simpler." The current debate about the global epidemic of non-communicable diseases - chronic conditions such as heart disease, stroke, diabetes, and cancer - has ignored this advice. Policymakers have oversimplified the challenge by focusing on the growing prevalence of non-communicable diseases - the sheer number of people with these diseases - which is not really the problem.

True, almost all regions of the world are experiencing an increase in the prevalence of these diseases, partly because as deaths from acute infectious diseases and injuries decline, people live long enough to develop them. But the diseases are increasing for many other demographic and epidemiological reasons as well, and understanding them has implications for health policy and even economic development.

In much of the world, populations are growing and aging simultaneously. Most non-communicable diseases increase in prevalence with age, a consequence of cumulative exposure to risk factors - including unhealthy behaviors such as tobacco use and biological risk factors such as high blood pressure - over a lifetime. All else being equal, larger and older populations mean more people with these conditions.

This "population aging" effect is well understood. Far less understood are the epidemiological forces that drive the dynamics of these diseases. From an epidemiological perspective, their prevalence is determined by the difference between the rate at which previously healthy people become ill - their incidence - and the rate at which ill people either recover or die (from any cause). If inflow exceeds outflow, prevalence rises.

Over the past several decades, standards of living, lifestyles, and biological risk factors have generally improved worldwide. (Obesity is an exception.) So, contrary to popular belief, the incidence of most non-communicable diseases other than diabetes has actually been falling. Nevertheless, their prevalence has increased because improvements in survival have outpaced reductions in incidence. Inflow and outflow have both fallen, but outflow has fallen farther and faster.

Severity effect

Several factors underpin the recent dramatic gains in survival at older ages. People living with a chronic disease may die not only from that disease, but also from other causes - including other such diseases, acute infections, and injuries. In particular, more accessible and higher-quality health care has significantly improved survival rates for people living with these conditions, including diabetes.

Yet health care is not solely responsible for the observed improvement in survival rates. Improvements in lifestyle and related risk factors have contributed as well. A decline in the proportion of people who use tobacco, have unhealthy diets, are physically inactive, or have elevated blood pressure and cholesterol does more than just prevent disease. Not only do fewer cases occur, but those that do tend to be less severe and to progress more slowly than was previously the case.

As a result, the increase in prevalence of many diseases in recent decades reflects an increase in the prevalence only of early stages of the disease. Increasing disease prevalence has hidden a decreasing prevalence of late-stage or complicated disease. I have called this shift toward the milder end of the disease spectrum the "severity effect."

Most health problems linked to non-communicable diseases - such as chronic pain, disordered sleep, depression, disability, and premature death - are associated with late-stage or complicated disease. Whenever the "severity effect" outweighs the "prevalence effect," the increasing overall prevalence of a disease will be accompanied by a decreasing health impact.

A paradox

This is the paradox of these diseases: Objective measures of poor health - severe symptoms, disability, premature death - are declining, even as the prevalence of these diseases is increasing. And while this paradox is no excuse for complacency in our response to what the United Nations has rightly called a global crisis, it does have practical implications for that response.

First, the primary concern should not be with reducing disease prevalence, but rather disease burden - the health impact as measured by disability and premature mortality. That means channeling resources according to burden rather than according to prevalence, particularly as co-morbidity - two or more diseases in the same patient - increases.

Second, we should concentrate less on improving health care and more on strengthening disease prevention, for example by driving down tobacco use, expanding opportunities for physical activity, and increasing the availability and affordability of a healthy diet. A focus on prevention can both reduce the incidence of non-communicable diseases and ensure that cases that do occur will tend to be less severe and will progress more slowly, allowing more inexpensive but effective treatment. Both lower incidence and lesser severity will contribute to a smaller disease footprint, even as disease prevalence continues to rise."

Increasing availability and affordability of a healthy diet? How about those melons and berries currently overflowing in the stores in JANUARY? How about that medicated-feed-laced meat they sell in grocery stores, but not much of anybody's buying?

We need to go back to Square 1 when it comes to defining "healthy" and we need desperately to remove the politics from our food--right now, major food producers are able to dictate what's "healthy" to us even without a shred of scientific evidence to back it up (unless they created it themselves, which is usually the case). Congress is all too willing to follow the money, even if it's waved right under their noses...witness such beauties as "pizza is a vegetable" and "fries are okay" in the school cafeterias. Federally-accredited health professionals will only tout the party line for fear of losing credentials, even though you and your insurance company are paying for solid diet and nutrition advice.

Then, in last place, we have Big Pharma, who gets paid if you get sick and STAY sick, and paid handsomely for as long as you live with a chronic disease or two...yep, more money to follow.

Are any of these people qualified to judge what's actually healthy and what's not? Follow your own money, and find out what's healthy for YOU, then do it---leave all these bozos in the dust, right along with this nit-picking over the terms "incidence" and "severity." Neither word belongs in our vocabulary!