Chronic disease is a serious and urgent population health problem. In Australia, chronic diseases (including cardiovascular diseases, cancers, chronic respiratory diseases and diabetes) and their biomedical risk factors (such as obesity, hypertension and high cholesterol levels) are the country’s biggest health challenge, responsible for 83% of premature deaths (deaths among people aged less than 75 years) and two-thirds of the total burden of disease.
The cost of chronic diseases to the community is considerable and growing. The Australian health system spends an estimated $27 billion a year treating chronic diseases – 36% of all health spending. However, this burden extends beyond impacts on the health system to impacts on individuals and their families, as well as to adversely impacting workplace productivity, workforce participation and economic growth.
Fortunately, many major chronic diseases are largely preventable. Behaviours such as smoking, alcohol consumption, poor nutrition and physical inactivity are responsible for many chronic diseases. These behaviours increase the risk because they raise blood pressure, lead to overweight and obesity, and cause high levels of glucose and/or fat in the blood.
Nearly all Australian adults have at least one risk factor for chronic disease – half of us have two or three. The World Health Organization estimates that 80% of all heart disease, stroke and type 2 diabetes and more than 40% of cancers could be prevented if known risk factors were eliminated.
Despite some successes, notably in tobacco control and associated reductions in lung cancer deaths and deaths from chronic obstructive pulmonary disease, Australia – like other countries – has been unable to successfully reverse or even contain the rising burden of chronic disease and their risk factors:
- 63% of Australian adults are overweight or obese
- 45% do not meet physical activity recommendations
- 48% consume too much sugar
- 18% drink alcohol at risky levels
- 33% have high cholesterol
- 23% have high blood pressure.
Like other countries, in Australia much effort to prevent chronic disease has focused on individual behaviour – encouraging people to eat more nutritious food, to move more, to not smoke and to drink less alcohol.
Health technologies have a role to play here:
- eHealth technologies, for example, have been successfully used to provide education and support through telehealth and telephone-based services
- mHealth technologies have also demonstrated effectiveness in promoting healthy behaviours, especially for increasing physical activity and/or weight loss and supporting smoking cessation through SMS/MMS, mobile apps, PDAs and remote or web technologies.
There is also growing interest in the use of genetic testing to improve diagnosis of predispositions to chronic disease and trigger individualised prevention efforts.
Efforts to change individual behaviour, even with the support from health technologies, are however fundamentally flawed. This is too narrow a view that does not recognise the dynamic interplay of the biological, social, physical, cultural and economic factors that combine in non-linear ways to shape individual choices, exposure, risk factor development and disease incidence and progression.
It is futile expecting an individual to exercise more if there is no safe, green space in the area in which they live. Equally, one can’t insist an individual eats a more nutritious diet, free from fatty, high-salt, fast foods if they can’t access fresh and affordable fruits and vegetables in their area.
Complex problems such as chronic diseases do not respond to simple, independent, one-off solutions that focus on one part of the problem, for example individual behaviours and individual choices. Rather, they require a deliberately coordinated portfolio of sustained, whole-of-population, inter-sectoral, cross-governmental actions. This requires a complex systems approach.
A complex systems approach to improving the prevention of chronic disease conceptualises poor health and health inequalities as outcomes of a multitude of interdependent elements within a connected whole. These elements affect each other in sometimes subtle ways, with changes potentially reverberating throughout the system.
A complex systems approach to chronic disease prevention would use a broad spectrum of methods to design, implement and evaluate interventions that recognise and intervene in the (connected) root causes of a problem.
Health technology has an important role to play in this, but only if integrated as part of a deliberately coordinated portfolio of actions that recognises and impacts on the complexity of chronic disease.
Tackling the whole system – where people live, work and play – will help us to create an environment that supports people to make better health decisions and avoid chronic disease.
This article was first published in the August 2017 edition of Focus, published by the Australian Academy of Technology and Engineering.