With our health systems strained by the simultaneous epidemics of monkeypox, polio and COVID-19, chronic diseases are not getting the attention they deserve. But as we continue to face ongoing threats from infectious diseases, we must build resilient health systems that are equipped to meet both public health emergencies and ongoing population health challenges.
Chronic diseases were already a serious problem in the US before the pandemic. According to the Centers for Disease Control and Prevention (CDC), one in six adults has a chronic disease, and four in 10 adults have two or more chronic diseases. These include diabetes, heart disease, cancer, chronic lung disease, stroke and chronic kidney disease. Chronic diseases account for seven of the 10 leading causes of death in the United States.
The COVID-19 pandemic has greatly affected chronic diseases directly and indirectly by disrupting preventive care and disease management and by contributing to high rates of morbidity and mortality. Heart disease, diabetes, cancer, chronic obstructive pulmonary disease, chronic kidney disease, and obesity are all conditions that increase the risk of severe illness from COVID. We’ve also seen the birth of a new chronic disease in “long COVID,” affecting nearly one in five Americans.
A growing number of studies show that COVID can increase a person’s risk of diabetes even months after infection. A Lancet study found that people who were infected with COVID were about 40 percent more likely to develop diabetes up to a year later than those in control groups. For every 1,000 people screened in each group, approximately 13 more people in the COVID group were diagnosed with diabetes. Even people who had mild infections and no previous risk factors for diabetes had an increased chance of developing the chronic condition.
Several studies have also highlighted how the pandemic has created a barrier to preventive cancer care. A 2021 study published on the impact of the pandemic on cancer services in Louisiana and Georgia found that there were nearly 30,000 fewer cancer pathology reports than in 2019, a 10 percent drop. Many reported delaying or skipping preventive care appointments for fear of exposure to the virus in 2020.
Without responding to the dual crisis of infectious disease threats like COVID and chronic disease, each will continue to amplify the negative effect of the other. This will only further strain our healthcare systems, ultimately creating barriers or reduced capacity to care for other healthcare issues.
Our health care system must align incentives to encourage payers, providers, employers, and individuals to better prevent, detect, treat, and manage chronic diseases before they become acute, costly problems. This starts with increasing access and removing barriers to primary care physicians and full integrated preventive care.
Primary care physicians are critical in helping patients prevent and manage chronic disease and provide referrals for other specialists who can help with their conditions.
According to a study by the Kaiser Family Foundation, a quarter of adults and nearly half of adults under 30 do not have a primary care physician. This disparity in care is worse for minorities. A 2020 study by the African American Research Collection found that blacks, Native Americans, and Hispanics reported having less access to a primary care physician than their white counterparts.
One positive impact of the pandemic has been the advent of telemedicine, especially for those in rural areas or healthcare “deserts.” New technological advances may also expand the role that telemedicine plays in providing care at home. Remote patient monitoring devices allow providers to monitor a patient’s progress remotely and receive alerts if there is a problem. To continue to reap the benefits of telemedicine, we must make emergency authorizations permanent and ensure payment parity for providers. Equal access to the Internet for all Americans is also necessary to reduce disparities 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 emerging technology tools such as big data analytics and genomic testing, providers can conduct early outreach and consistent follow-up, monitoring and management of patients more effectively in their homes, while cultivating a deeper understanding of how, why and where chronic diseases develop.
By investing in resilient health systems to address public health emergencies and chronic diseases, we can promote healthy longevity for all.
Dr. William Haseltine is president of ACCESS Health International and will moderate two expert panels on Metabesity 2022 Conference on how lessons from the COVID-19 pandemic can prepare us to address the ongoing chronic disease epidemic.