Monday 19 February 2018

Report lays bare alarming cost of our poor lifestyle

Chronic disease accounts for no less than 80pc of all GP visits and 40pc of hospital admissions

Minister for Health Simon Harris at a viewing of plans for the new children's hospital in Dublin on Friday Photo: MAXWELLPHOTOGRAPHY.IE
Minister for Health Simon Harris at a viewing of plans for the new children's hospital in Dublin on Friday Photo: MAXWELLPHOTOGRAPHY.IE
Jody Corcoran

Jody Corcoran

The first thing you want to do when you read the 'strategic note' prepared by officials for the new health minister, Simon Harris, is go for a health check-up. For any middle-aged man (or woman), the passages related to lifestyle represent a sobering analysis.

The first realisation, however, is that for all the criticism, and all its shortcomings, the Department of Health seems to be well across the issues and is refreshingly honest in its presentation to the minister.

For example, it says the starting point for a more effective and integrated model of care is the development of comprehensive primary care and it describes the existing system as "unsustainable".

"To meet future health needs on a more sustainable basis, a much more effective and modern operating model will be required," it states.

The scale of the challenge facing the health service is also laid bare: Irish people are living longer. Between 2003 and 2013, life expectancy for men increased from 75.7 years to 79 and for women from 80.7 to 83.1.

"Population ageing is no longer a future eventuality - it is a present day reality that is being felt on the front-line of our health services," the note states.

Approximately 38pc of Irish people over 50 have one chronic disease (conditions which are not acquired from someone else and which are of long duration) and 11pc have more than one.

In fact, chronic disease accounts for 80pc of all GP visits, 40pc of hospital admissions, and 75pc of hospital bed days.

Around three-quarters of health service activity relates to dealing with chronic disease, sometimes multiple chronic diseases - illnesses which, of their nature, are ongoing and therefore require ongoing care and substantial co-ordination.

While mortality from major chronic diseases has improved in recent years, the burden of chronic disease in the population is large.

According to the document, studies have estimated that up to 250,000 people in Ireland are living with diagnosed cardiovascular disease and up to 440,000 suffer from chronic obstructive pulmonary disease, many of whom are undiagnosed.

Approximately 30,000 new cancer cases are diagnosed every year, with a further 90,000 people living with cancer. In addition, studies estimate that 9pc of the population over 45 have diabetes.

It is estimated that the prevalence of major chronic diseases will increase by 20pc by 2020, largely driven by an ageing population and improved survival rates.

The number of people with cancer, cardiovascular disease, diabetes and respiratory disease is projected to increase by 4-5pc per annum. Cancer estimates project a 70pc increase in cases in females and an 83pc increase in cases in males between 2015 and 2040.

The burden of chronic diseases and the lifestyle factors that contribute to them "rests more heavily in the lower socioeconomic groups".

Within the acute hospital sector, 55pc (€1.68bn) of the budget is attributable to care of patients with these chronic conditions, admitted as a direct consequence of their illness or where the illness was a contributory factor. Eighty-six per cent of deaths and 77pc of disease burden are caused by chronic disease.

Lifestyle factors including tobacco and alcohol usage, together with physical inactivity, poor diet and obesity, are key risk factors, along with high blood pressure and cholesterol, for chronic disease.

In Ireland, 5,200 people die from tobacco-related illness each year, mainly from cancers, respiratory and cardiovascular diseases; 30pc of all cancer cases and deaths due to cancer are attributable to tobacco consumption.

The average alcohol consumption in the adult population in Ireland is 11 litres (pure alcohol per person per year).

According to the document, alcohol-related harm results in a "considerable burden to society through illness, violence, accidents, work absences, crime and premature mortality".

Alcohol consumption increases the risk of over 60 illnesses, including liver disease, hypertension, certain cancers and mental health disorders. In addition, it is a contributing factor in many cases of domestic violence, public order offences, road traffic accidents and suicides.

Over 75pc of the Irish population drink alcohol, with almost 40pc binge-drinking on a typical drinking occasion.

It warns that there is a real danger that the health gains in life expectancy made from addressing factors such as smoking, high blood pressure and high lipid levels will be reversed due to the rising prevalence of obesity. The cost of obesity to the State in 2009 was estimated at €1.13bn. A 5pc reduction in overweight and obesity levels will result in a €495m reduction in direct healthcare costs attributable to obesity and overweight-related morbidity over 20 years.

The report also repeatedly emphasises that the Department of Health's aim is to enhance health and well-being, not just to provide services, adding: "Prevention is therefore a vital part of any strategy.

"The benefits of physical activity are extensive. Not only does physical activity prevent disease, it also promotes wellbeing. Being physically active on a regular basis reduces one's risk of cardiovascular disease, diabetes and some cancers. It has also been shown to improve mental health, reducing symptoms of depression and anxiety."

Sunday Independent

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