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
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.
Bloom, D.E., Cafiero, E.T., Jané-Llopis, E., Abrahams-Gessel, S., Bloom, L.R., Fathima, S., Feigl, A.B., Gaziano, T., Mowafi, M., Pandya, A., Prettner, K., Rosenberg, L., Seligman, B., Stein, A.Z., & Weinstein, C. (2011). The Global Economic Burden of Noncommunicable Diseases. Geneva: World Economic Forum.
Glechner A, Harreiter J, Gartlehner G, Rohleder S, Kautzky A, Tuomilehto J, Van Noord M, Kaminski-Hartenthaler A, Kautzky-Willer A. (2014). Sex-specific differences in diabetes prevention: a systematic review and meta-analysis., Diabetologia. 2015 Feb;58(2):242-54. doi: 10.1007/s00125-014-3439-x. Epub 2014 Dec 3. Review. https://www.ncbi.nlm.nih.gov/pubmed/25465437
HLS-EU Consortium (2012). Comparative Report of Health Literacy in Eight EU Member States. The European Health Literacy Survey HLS-EU on line publication: HTTP://WWW.HEALTH-LITERACY.EU
Hofmarcher MM. (2013). Das Österreichische Gesundheitssystem, Akteure, Daten, Analysen, Medizinisch Wissenschaftliche Verlagsgesellschaft 2013, Berlin 2013
Hofmarcher MM., J. Simon, G. Haidinger (2017). Stroke-units in Austria: incubators for improved health outcomes, Health Systems Improvement Across the Globe: Success Stories from 60 Countries. Edited by Jeffrey Braithwaite, Russell Mannion, Yukihiro Matsuyama, Paul Shekelle, Stuart Whittaker and Samir Al-Adawi. CRC Press 2017. Print ISBN: 978-1-4724-8204-4. eBook ISBN: 978-1-317-12328-6. https://doi.org/10.1201/9781315586359
IHME 2010 Institute for Health Metrics and Evaluation (2010). Global burden of diseases, injuries, and risk factors study 2010, Country report Austria, USA, Seattle, 2010. https://www.healthdata.org/sites/default/files/files/country_profiles/GBD/ihme_gbd_country_report_austria.pdf
Kautzky-Willer A, Dorner T, Jensby A, Rieder A. (2012). Women show a closer association between educational level and hypertension or diabetes mellitus than males: a secondary analysis from the Austrian HIS., BMC Public Health. 2012 May 30;12:392. doi: 10.1186/1471-2458-12-392. https://www.ncbi.nlm.nih.gov/pubmed/22646095
Kautzky-Willer A, Harreiter J, Pacini G. (2016). Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus., Endocr Rev. 2016 Jun;37(3):278-316. doi: 10.1210/er.2015-1137. Epub 2016 May 9. Review. https://www.ncbi.nlm.nih.gov/pubmed/27159875
Kautzky-Willer A, Thurner S, Klimek P. (2016a). Use of statins offsets insulin-related cancer risk., J Intern Med. 2017 Feb;281(2):206-216. doi: 10.1111/joim.12567. Epub 2016 Oct 21. https://www.ncbi.nlm.nih.gov/pubmed/27766700
Kautzky-Willer A, Harreiter J. (2017). Sex and gender differences in therapy of type 2 diabetes., Diabetes Res Clin Pract. 2017 Sep;131:230-241. doi: 10.1016/j.diabres.2017.07.012. Epub 2017 Jul 13. Review. https://www.ncbi.nlm.nih.gov/pubmed/28779681
Klimek P, Kautzky-Willer A, Chmiel A, Schiller-Frühwirth I, Thurner S. (2015). Quantification of diabetes comorbidity risks across life using nation-wide big claims data., PLoS Comput Biol. 2015 Apr 9;11(4):e1004125. doi: 10.1371/journal.pcbi.1004125. eCollection 2015 Apr. https://www.ncbi.nlm.nih.gov/pubmed/25855969
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Nichols M, Townsend N, Luengo-Fernandez R, Leal J, Gray A, Scarborough P, Rayner M (2012). European Cardiovascular Disease Statistics 2012. European Heart Network, Brussels, European Society of Cardiology, Sophia Antipolis
ÖPGK. Österreichische Plattform Gesundheitskompetenz: https://oepgk.at
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Wilkinson, R., & Marmot, M. (2003). Social Determinants of Health: The Solid Facts (2nd ed.). Copenhagen: WHO Regional Office for Europe.
- a focus on serious chronic diseases, their prevention, early detection and treatment options; particular attention to rare diseases.
- structured information and quality discourse on the effects of digitization.
- Consideration of ethical aspects in the context of the geneticisation of medicine.
- to provide gendersensitive information preparation: newsletter, infographics, targeted also for self-help groups.
- to forecast and toolbox models for the sustainable financing of care.
- strengthening of health competence in all areas.
- investments in the coordination of health and care services.
- functioning supply structures must not be destroyed.
- “Knowledge Lab of chronic care programs“ (“What works for whom and how?“)