Comments of Chapter 9: Socioeconomic implications

 Why is this topic important?

It is now obvious that the demand for health services is outstripping available resources in every society in the world, threatening not only the sustainability of the health system, but that of the economy as a whole. The prolongation of life expectancy is one of the factors most closely associated with this challenge. In the United States, for instance, the cost of healthcare for people over the age of 85 is six times greater than in people aged 50 to 54 and twice as much as in the 75-79 age group (1). There are different theories about how the increase in life expectancy relates to the burden of disease and its associated cost. The expansion of morbidity theory holds that the number of years humans will live with disease will increase (2), while the compressiontheory (3) describes a scenario in which a gain in years of healthy life will of morbidity lead to a postponement in disease and cost to more advanced life stages (i.e. they are compressed into that age segment). These different views have important social, political and economic implications. If, as a society, we invest resources to prolong the life of patients, this will expand their morbidity, while if we target risk and lifestyle habits we will probably delay and contract morbidity (4).

Regardless of how societies decide to meet the challenges associated with chronic diseases, any political or economic measure would need to take into account the fact that most of the costs are not associated with clinical services but with productivity losses (5, 6), and that expenditure on long-term care will represent an increasing proportion of healthcare costs in every economy, even in the most optimistic forecast models of cost containment (7). This will likely be compounded as the number of chronic diseases in the same person increases (8).

Despite the seriousness of the situation, neither organizations nor governments are decisively adopting measures to fight the chronic disease epidemic. Some consumer organizations do focus on the medical treatment of specific diseases, sometimes acting as pressure groups to increase investment in treatment, neglecting health promotion and disease prevention. Global donors are spending most of their funds on countering infectious disease and improving maternal and child health: very few resources are dedicated to countering chronic disease, and even fewer to tackling the challenges associated with polypathology.

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