Our experience with COVID-19 is highlighting the urgent need to do much more to prevent chronic diseases, according to Emma Lonsdale, Executive Officer, Australian Chronic Disease Prevention Alliance.
Emma Lonsdale writes:
After years of trying to drum up government interest in chronic disease prevention, the past few months have sharply demonstrated the value of prevention as a tool to sustain healthy communities.
Our experience with COVID-19 makes a strong case for prevention and early detection. The benefits are clear as case numbers start to fall within weeks of major policy decisions.
Each day brings updates with new data on cases, hospitalisations, deaths, and tests undertaken. Governments are responsive to these figures and accountable for their decisions. And we are invested in the outcomes, keenly aware that decisions at the top will impact our health and day-to-day lives.
Prevention and early detection have emerged as the often-unsung health heroes, as governments attempt to navigate a path that curbs the spread while maintaining the economy. Preventing new cases and quickly detecting existing cases has been paramount to halting community transmission.
Preventive health measures, like physical distancing, handwashing and facemasks are heavily promoted through awareness campaigns and reminders. Personal protective equipment (PPE) is crucial to prevent transmission amongst health and aged care workers, while border controls serve to limit the spread around the country.
Easy access to testing clinics and broad testing criteria helps to identify cases early and complement the exhaustive contact tracing undertaken by health departments.
All these measures are designed to slow the wave and prevent our hospitals from being overwhelmed.
In response to the urgency of COVID-19, governments acted swiftly to implement a wide range of policy measures through streamlined departmental approval processes and a new “national cabinet” decision making model.
There is no silver bullet – at least until a vaccine is safely available – and so a combination of voluntary and mandatory approaches has been selected to slow the spread. While we are being asked to change our behaviour, government regulations have been designed to support changes to our environments and expectations.
The same approach could be used effectively to prevent chronic disease.
While not infectious, the relentless increase in chronic diseases is no less urgent.
Chronic diseases are the leading cause of death in Australia. One in two of us are affected by diseases like cancer, heart disease, stroke, diabetes, or kidney disease. These conditions consume healthy years of life through premature death and long-term complications.
Yet nearly 40 percent of chronic disease burden could be prevented by reducing risk factors like unhealthy diets, smoking, physical inactivity, alcohol consumption, unhealthy weight, and high blood pressure.
Like COVID-19, there is no silver bullet. We need a combination of voluntary and mandatory approaches to create environments that support us to reduce our risk.
Despite the growing burden of chronic disease, for years governments have focused on individual responsibility. As COVID-19 demonstrates, this is not enough. Regulation is necessary to change environments and support change. At the same time, we need to hold governments to account and demand change.
Unlike COVID-19, there is no need to create policy on the run. There are mountains of evidence supporting government actions to combat the rising tide of chronic conditions by creating healthier environments and implementing early detection measures.
A leading source of global health advice during COVID-19, the World Health Organization, recommends 16 Best Buys to prevent and control chronic disease. These are evidence-based, cost-effective and feasible solutions to reduce risk factors like smoking, alcohol, unhealthy food, and physical inactivity across the population.
In Australia, evidence shows there is a $14 return on investment for every dollar invested in public health interventions. That is an enviable return, especially when treating existing chronic disease consumes around one-third of the national health budget each year.
Beyond the financial costs, let’s not forget the burden on individuals, families, and communities. Surely an investment that delivers a strong financial return and improves population health and wellbeing would be worth striving for.
Ten years ago, Australian researchers recommended a set of prevention interventions, including 43 very cost-effective interventions that were expected to generate large cost savings over time by reducing the development of chronic disease.
A decade later and we are still waiting for action. Over time, more hospitals have been constructed and costly drugs added to the Pharmaceutical Benefits Scheme while prevention is, yet again, overlooked.
But COVID-19 has made the case for prevention by demonstrating its immediate impact in a very tangible way.
On the other hand, chronic disease prevention requires long-term vision and sustained commitment, with the results worth staying the course. Australian has led this vision in our approach to smoking cessation, which is world leading and continues to evolve.
Promisingly, the government recently released a public paper to inform a new National Preventive Health Strategy. This is a commitment by the Minister for Health and the paper builds on individual responsibility to support change at the system-level.
The strategy is a start and it will need to be backed by government investment to have any real effect. Importantly, the strategy must extend beyond the health sector to address broader social determinants of health and reduce existing inequities. We cannot afford to let another ten years slip by as countless more are diagnosed with chronic disease and suffer from long-term preventable complications.
There is a real fear that, during this pandemic and particularly during lockdowns, risk factors are increasing. While there are reports of flourishing bike sales, the readily available deliveries of alcohol and unhealthy foods are likely to contribute to ‘corona kilos’.
Around two in three Australians are already overweight or obese and there is a risk that weight gain during COVID-19 will be hard to shed. Overweight and obesity is a leading risk factor for many chronic diseases, but if everyone in Australia was a heathy weight, we could reduce diabetes burden by 53 percent, chronic kidney disease by 38 percent, stroke by 22 percent, heart disease by 25 percent and some cancers by up to 38 percent.
Looking for leadership
Now, more than ever, we need government leadership for the long-term health and wellbeing of Australians.
Last week was the Global Week for Action on NCDs (non-communicable diseases or chronic diseases).
In a year that has been consumed by COVID-19, we cannot afford to ignore the enormous burden of chronic conditions. But we can learn from the success stories of prevention and early detection in the fight against COVID-19.
We have the evidence. We have the proof. Now is the time to act to prevent chronic disease.
Emma Lonsdale is Executive Officer, Australian Chronic Disease Prevention Alliance.
The Australian Chronic Disease Prevention Alliance (ACDPA) brings together Council Australia, Diabetes Australia, National Heart Foundation of Australia, Kidney Health Australia, and Stroke Foundation to collectively advocate for prevention, integrated risk assessment and effective management of chronic disease risk.