The Foundation of our Health Care System has Changed: New England Journal

February 3, 2012 - Yesterday’s New England Journal has a brief history of acute infectious diseases and a plea for continued vigilance. It declares how such diseases played an important part in the history of medicine and celebrates success in combating them through vaccination and scientific research. Although it somewhat overstates the benefits due to medical advance, it appropriately recognizes that our current medical system was founded when such diseases became understood and began to be dealt with.

It is also interesting that it says almost nothing about patient participation in health maintenance and improvement. Interestingly it looks to research that seeks to find infectious agents as the cause of conditions such as “obesity and inflammatory bowel disease.” But it does not acknowledge that current morbidity is largely not due to such diseases. The vast majority of illness and mortality is a result of non-communicable diseases as reported in a recent report from the World Health Organization (it is fascinating to me that a recent New England Journal article speaks oxymoronically of the “epidemic” of non-communicable diseases). About 90% of deaths in developed countries are due to such non-communicable diseases as diabetes, health disease, and cancer.

What is most important about this change is that long term chronic conditions require far more patient participation in their care than do communicable diseases. And the system that was constructed to deal with acute infectious diseases has had little room for patients to contribute to their care or to avert acute episodes. Although we must continue to be vigilant to avert mass outbreaks of infectious diseases, we must really begin to face the fact that most illness is chronic and non-communicable.

Patients must participate in all aspects of a health care system that deals primarily with non-communicable disease. Join us and begin to participate.