Tackling complex chronic conditions - Apply what we already know

Abstract

“Global Burden of Disease 2010” estimates that 54% of all Disability-Adjusted Life Years (DALYs) worldwide and the top 10 causes of DALYs in high-income Asia Pacific as well as East Asia can be attributed to non-communicable diseases (NCDs). In post-modern Hong Kong, the attributable fraction due to NCDs can only be more burdensome. Whereas hospitals and by extension specialist clinics are the final common pathway for patients with NCDs, the solution to tackling this burden is of course upstream along the referral chain in primary and preventive care. Rose’s prevention paradox specifies a more nuanced but no less intensive approach towards purveyors of processed foods as per big tobacco. It also requires pervasive attention in all policies and deliberations regarding health impact, just as environmental impact assessments are de rigeur. Dahlgren and Whitehead’s conceptualisation of social determinants and Marmot’s World Health Organisation Commission findings instruct that root causes be identified and addressed, whereas victim blaming must cease. Alma Ata and Starfield’s empiricism have demonstrated the utility and economy of primary care. Screening should be meticulously evaluated then judiciously applied according to Lalonde’s “populations at risk” approach. Research must continue into better understanding pathogenesis as well as devising therapeutics. Nothing less than a comprehensive strategy, however incrementally but systematically executed and measured, will suffice to mitigate this complex, chronic burden of NCDs. Health and wellbeing aside, our productivity and economy depend on its success.