Europe’s high-stakes chronic disease burden demands urgent, comprehensive strategies

The growth of Europe’s chronic disease burden is of serious concern for the sustainability of healthcare services. In Europe, the prevalence of chronic diseases and conditions such as cancer, diabetes, heart disease, chronic respiratory disease, and mental health problems present the greatest challenges.

4 million people die each year in the EU as a result of a chronic disease, accounting for 85% of all EU deaths.  It is well documented that Europe has an ageing population but seniors are not the only cohort affected by chronic diseases. Rising numbers of young and middle-aged people have some form of chronic health problem. Besides the loss of life and the associated human tragedy, the economic and social implications are also serious. Chronic conditions account for up to 80% of all healthcare costs.  Chronic illnesses depress wages and productivity whilst increasing absenteeism, early retirement and disability. 

Since early 2020 the battle against the COVID-19 pandemic has shifted healthcare priorities away from the care of chronic diseases. Pandemic-shocked health systems are now picking up the pieces, confronted with the fallout from many missed diagnoses, delayed treatments, and  consequent higher mortality rates. COVID-19 has a circular connection to chronic diseases: those with a chronic condition are more susceptible to the virus while those who had a severe form of COVID-19 are more prone to acquiring a chronic illness. The evidence upon which to make a definitive assessment of COVID-19’s impact is still emerging. For example, research by Mayo Clinic found that people under 45 had a threefold increased risk of severe COVID-19 infection if they had a pre-existing chronic illness.

Before the pandemic, healthcare systems were still recovering from cuts resulting from the financial crisis. Since 2000, the number of hospital beds per capita decreased in all EU countries. COVID-19 laid bare health systems’ capacity limitations and magnified disparities between population groups within countries and between countries in Europe. These inequalities highlighted vulnerabilities in populations as well as increasing differences in health behaviours and outcomes. Racial minorities and poorer people bear a disproportionate burden of morbidity and mortality when it comes to chronic illness.  Often, it’s those most in need of affordable public healthcare who are unable to gain equal access to high quality healthcare.  

The convergence of these issues and their impact on chronic diseases and care present challenges but also unique opportunities for transformation. Mitigating Europe’s chronic disease crisis demands stronger and more urgent political will -making sometimes unpopular policy decisions, and driving innovation at scale to move from treatment to prevention.  COVID-19 has nullified the notion of the impossible, the challenging, and the complex. The pandemic prompted urgent responses in many health sectors that can now provide models for rapidly developing real-world solutions to improve efforts focused on tackling the scale of chronic ill-health. Exemplars could be real-time, in-depth tracking of chronic health conditions, just as rapid data dashboards were used to track COVID-19 cases, hospitalisations, and deaths. Effective strategies to prevent and treat chronic health conditions require better and more readily accessible information. Implementation of transformative care and measurement of its outcome depend on reliable real world data.

Chronic diseases are a complex interplay between genetics and environmental factors, how and where we live, and are not amenable to simple treatment regimes.  There is no doubt that we are at a critical inflection point for healthcare in Europe - the clock is ticking loudly. A transformative paradigm shift in health care systems is required - prioritising data-driven healthcare – using robust ‘big data’ to inform critical policy-making decisions and place equity at the centre for future healthcare sustainability. Big data holds the key to dramatic, rapid improvement in disease prevention. Targeted ‘personalised healthcare’  will allow the “right” treatment to reach the “right “patient at the “right” time, moving away from the predominant ‘one-size-fits-all’ and shift health systems from being treatment-centred to being comprehensively patient-centred to enhance outcomes in chronic disease management.  Policymaking needs to tackle infrastructural gaps to bridge the digital divide to optimise digital and personalised healthcare capabilities and create future-ready health systems for chronic diseases as well as acute illnesses. We need to improve health data sharing to inform more effective and efficient prevention and treatment protocols and programmes for chronic diseases. 

Care pathways should be aligned with the needs of people living with a chronic illness – that is, evidence-based integrated care. We need to aggressively address structural inequities to eliminate disparities, remove barriers and increase diversity, access, and inclusion for all.  Finally, we have to ensure that the social determinants of health are incorporated at all levels of health, from research to clinical care and within communities and society, for equitable, systemic improvements in health outcomes for chronic conditions to be realised.

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