Whose health is it? Chronic disease

From the patient’s perspective, the question is: “Hey! Whose health is it?”

PATIENT B presents with morbid obesity; develops diabetes type 2 and dies prematurely from heart disease.

Who is responsible? Are the external contributing influences liable for the patient’s demise? Was the morbid obesity caused by the parents and their poor dietary habits? Is it reasonable to finger supermarkets given their aggressive promotion and sale of junk food, the dangerous consequences of which are scientifically documented?

Does culpability lie with media outlets, all of whom profit from advertising potentially life-threatening food?

Are we, as a community, accountable?

What role should Federal and state governments play in protecting the vulnerable from predatory advertising? Should they be expected to protect people from themselves?

From the patient’s perspective the question is vexed.

Chronic disease management represents 37 per cent of all hospitalisations, and is exerting an enormous strain on the health system.

The Grattan Institute reported the cost of preventable hospital admissions due to ‘ineffective management’ of chronic disease at $320 million a year.

It is one of the major challenges confronting the Australian community. The total cost of treating chronic disease is estimated at $27 billion annually and represents more than a third of our national health budget.

The integration of some of today’s leading internet-connected technologies is driving a fourth industrial revolution.

Technology has altered, irreversibly, how we live, and how we will live in the future. We are on the periphery of a brave new world.

We are confronting challenges of gargantuan proportion, probably the like of which we have never encountered. COVID-19 has exposed a total lack of contingency preparedness for an international calamity.

Everyone, regardless, has a megaphone to the world.

Socio-economically we are struggling to keep apace. Misguidedly, lest we appeared to be clinging to the past, we too enthusiastically threw-out the baby with the bathwater, discarding effective procedures for the sake of change.

If we are to slow the rate of deaths from chronic disease we must alter, radically, our holistic mindset.

It will take commitment, education, money, and a combination of the old and the new as we lurch into our unknown technological and medical future.

The demise of patient B raises serious attitudinal issues.

Australia’s current health system is designed to fail. According to Victoria University’s Mitchell Institute, “Our health system is designed to cure, and that means something has to go wrong first. We need to start treating people, rather than treating diseases.”

From a patient’s perspective, that is cause for concern, remembering that what we all sell is risk and responsibility.

So radically are the changes in our social mores and behavioural landscape, if a fallen World War Two soldier were to visit, they would not recognise the place. The wake of the social revolution is problematic.

Who is to blame for the death of patient B?

The health department, drug companies, food, liquor and cigarette manufacturers; even the patient, his family and friends, could be accused of an abrogation of responsibility.

Is his death criminal negligence, or a tempered version of institutional manslaughter?

Conversely, it could be argued, everything in moderation; however, like heroin, sugar is addictive, and known to be a silent killer.

Overwhelmingly, there is a financial discrimination in supply and delivery. A health policy expert at Victoria University’s Mitchell Institute said, “The best thing you can do for your health is to be wealthy.”

As of 2011, government statistics show the rural mortality rates are 1.4 times higher than those in major cities; death from diabetes is between 2.5 times and four times more likely; and suicide rates increase between 1.8 and 2.2 times.

About a third of chronic disease is preventable; paradoxically, Australia spends only $2 billion annually on preventive health each year, or a meagre $89 per person.

Of 38 OECD countries, Australia is ranked 16th by per capita expenditure.

Detrimentally, Australians are prepared to spend more money on a luxury car than their private health insurance.

There is an attitude of entitlement: a mindset of ‘let the government pay’. Consequently, the public health system is buckling under the burden.

Leading causes of death is a useful statistical measure of population health.

The top five chronic disease killers, above the higher proportion of contribution from diabetes types 1 and 2, would be coronary artery disease – plaque build-up in the wall of the arteries supplying blood to the heart, cerebrovascular – stroke, kidney disease – renal failure, peripheral vascular – narrowing of arteries, and arterial aneurysms – dilatation in the wall of an artery.

The medical system is curative rather than preventative.

If we are to meet the mounting challenges of chronic disease, we must implement a philosophical shift in theory and application. In short: we must change our methodology, without delay.

From the patient’s perspective it is both challenging and distressing.