Chronic Care

Chronic care

Prevent, identify, treat correctly

Chronic diseases, their early detection and treatment options must be brought into focus. In the future, these diseases will affect even more people than today – men and women differently. We need more and better care programmes for specific diseases and more health literacy for people. Improved coordination of services between health and care is also a must.

The World Health Organization (WHO) describes chronic conditions as noncommunicable diseases. These are diseases that develop slowly, last long and cause a high burden of disease [WHO 2005]. This category mainly includes cardiovascular diseases, respiratory diseases, malignant neoplasms, diabetes mellitus, neuropsychiatric conditions and diseases of the musculoskeletal system. These diseases often occur in combination with other conditions (co-morbidity) and their causes cannot always be determined [Kautsky-Willer et al 2012; Klimek et al 2014; Kautsky-Willer et al 2016; Turner et al 2013]. In the coming years, more and more people will be affected as life expectancy increases and the world population increases. Chronic suffering reduces a country‘s productivity and causes expenditure on health to rise sharply. This is particularly true of cardiovascular disease and mental illness [Bloom et al 2011].

Lifetime in chronic diseases: 15 countries in comparison

IHME 2010

How to live healthy longer?

All this also applies to Austria – even though the efficiency of our health system is constantly improving in many areas. For example, survival rates in cancer, cardiovascular diseases and stroke have risen sharply [Nicholos et al 2012]. In comparison with other developed countries, the burden of stroke-related diseases in Austria halved between 1990 and 2010 [IHME 2010, Hofmarcher et al 2017]. Better acute care means that although Austrians can enjoy a high life expectancy, they live healthier lives shorter than people in other rich EU countries [Hofmarcher 2013]. In addition there are considerable differences in healthy life expectancy between the federal states. This is due to the large differences between men and women [Klimont et al 2017; Glechner et al 2014; Kautsky-Willer et al 2016a; Kautsky-Willer et al 2017]. Social risk factors and lifestyle could be responsible for the above-average length of life in impairment. For children under the age of five, tobacco and alcohol consumption by adults is particularly harmful [IHME 2010].

The main causes of impaired lifetime in Austria are primarily back pain, severe depression, neck pain and other musculoskeletal disorders [IHME 2010]. Desease burden due to falls has increased significantly between 1990 and 2010, while it decreased in accidents and suicides.

What are the benefits of health literacy?

People in Austria have comparatively low health literacy. Above all, there is a lack of knowledge about health care and patient rights, but knowledge about prevention and health promotion also leaves much to be desired. In addition, there are strong regional differences: about 36% of Vorarlberg residents show limited health competence, but 63.3 % of people in Styria do. In comparison, Austria has the strongest correlation between health literacy and socio-economic living conditions and between age and gender [HLS-EU Consortium 2012]. The perception of pain is also related to the level of education. People with high health competence have less intense pain [Köppen et al 2018]. Practical, financial and emotional support plays an important role especially for poorer population groups – especially in economic crises. Such support has a positive impact on several health outcomes, including those of people suffering from chronic diseases [Köppen et al 2018]. [Wilkinson & Marmot, 2003].

Lack of health literacy often leads to health risks and little physical activity. On average, more than twice as many Europeans as people in Austria exercise almost daily. This can lead to significant cost increases for our health system. It can also be assumed that poor health literacy in Austria is likely to lead to more hospital stays [HLS-EU Consortium 2012].

Countries with strong social safety nets tend to have fewer social inequalities in health. Austria has a functioning social safety net, but there is a lot of catching up to do in terms of health competence and the further development of health care structures. This applies above all to risk groups and persons with chronic illnesses. The Austrian Platform for Health Competence ÖPGK was founded in 2014. It supports the implementation of the national health goals and health promotion strategy.

Better cooperation and coordination is needed

But more needs to be done. Our health system needs more cooperation and coordination. The coordination of care between established doctors and hospitals is inadequate. The cooperation between the health and care sectors is not sufficiently well-rehearsed. It is precisely such models that are becoming increasingly important, however, because the quality of services for chronically ill people must be improved – and as cost-effectively as possible.