Even the United Nations is concerned - UN convenes over non-communicable diseases

[Ed. note: we are pleased to welcome Nicole Cornett to HRW. She is a fourth year evening student at Seton Hall Law School and is currently a Senior Program Manager for Novartis Pharmaceuticals in Oncology.  After completing an undergraduate degree in Biology and Chemistry at the Richard Stockton College of New Jersey, Nicole joined Novartis as an Analytical Chemist and began the Masters of Business Administration program at Seton Hall University.  Upon completion of her MBA in Management she transitioned into Program Management in Oncology and shortly after enrolled in Seton Hall Law School's evening program, pursuing a J.D. with a concentration in Health Law.  Nicole continues to support a broad spectrum of drug development activities, and has received various corporate awards including a President's Award in 2010.  She is particularly interested in drug regulatory policy and global healthcare systems.]

In 2001, amidst an atmosphere of fear and ignorance, a UN General Assembly Special Session on AIDS raised HIV/AIDS to the level of seriousness it so rightly deserved.  There are some who credit the meeting with the formation of the Global Fund to fight HIV/AIDS, Tuberculosis, and Malaria.

Ten years later (September 19-20, 2011) a high-level meeting of the General Assembly convened in New York on the prevention and control of non-communicable diseases (NCDs).  Why now? Because the environment of fear and ignorance has been replaced with recognition of the potential risk that these diseases pose for economic burden.  Diseases such as cardiovascular disease, respiratory disease, diabetes, and cancer pose a major risk to productivity, healthcare costs, poverty, and economic growth.  In September of 2011 the World Economic Forum released a report entitled The Global Economic Burden of Non-communicable Diseases, in which they discuss an assortment of variables that will lead to an increased rate of NCDs and therefore an increased burden on the global economy, as well as local economies.  The findings of their research paint a dire picture of rising prevalence, increasing costs, an aging population, and the cumulative output loss as a percentage of Global GDP.

To assess the affect of NCDs on economic burden the authors of the report describe three methods used to quantify: 1) the cost-of-illness approach, 2) the value of lost output: the economic growth approach, and 3) the value of statistic life approach.  The report elaborates on each method, but essentially each provides an assessment of economic burden from a different perspective, and each has strengths and weaknesses that should be considered when viewing the results.  Here are some of the conclusions the report sites (these bullets should encourage you to read the report):

• Value of Lost Output approach: lost output from five conditions (cancer, cardiovascular disease, chronic respiratory diseases, diabetes and mental health) over the period 2011-2030 is estimated at nearly US$ 47 trillion.
• Value of statistical life approach: the economic burden of life lost due to all NCDs ranges from US$ 22.8 trillion in 2010 to US$ 43.3 trillion.
• Cost-of-illness approach: estimates of direct and indirect costs of ill health for five distinct disease categories are:
  • Cancer: an estimated US$ 290 billion in 2010 rising to US$ 458 billion in 2030.
  • Cardiovascular disease: an estimated US$ 863 billion in 2010 rising to US$ 1.04 trillion in 2030.
  • COPD: an estimated US$ 2.1 trillion in 2010 US$ rising to US$ 4.8 trillion in 2030.
  • Diabetes: an estimated nearly US$ 500 billion in 2010 rising to at least US$ 745 billion in 2030.
  • Mental illness: an estimated US$ 2.5 trillion in 2010 rising to US$ 6.0 trillion by 2030.

Thankfully, the report goes the extra mile and discusses possible interventions (most identified by WHO) identified as “best buys” because they are cost-effective, feasible and appropriate for use in low-middle income countries.  Examples of these interventions include tax increases to tobacco and alcohol products, counseling on cardiovascular therapies, education on diet and physical activity, and preventative medicine/screening.

In the US, we should pay particular attention to what can and should be done to tackle the issue of NCDs, and bear in mind the hazards of not doing so.  After the recent debt-ceiling-debacle we can all expect much greater scrutiny into government spending.  This will include expenditures on educational programs for diet and exercise, smoking cessation, diabetes, etc.  The cost/benefit analysis must determine these programs to be of unquestionable importance.

Just the other day I heard a political analyst on a mainstream news program state that it’s unfortunate for Barack Obama that the Supreme Court will likely hand down a decision on the constitutionality of the healthcare reform law in the midst of heavy presidential campaigning because it serves as a reminder that instead of focusing on the economy, Obama was immersed in healthcare reform.  The statement highlights the issue of mindset.  The availability and affordability of healthcare cannot be considered independent of economic health.  Instead, it should be considered a direct factor in addressing the root cause of our struggling economy.  To put it another way, Obama’s focus on healthcare reform was a direct effort at rehabilitating the US economy by targeting a source of financial strain on the government and the public, as well as reducing the affect of disease on the productivity of society.

It will be increasingly important for global leaders to recognize the role healthcare plays in economic health and growth.  It’s encouraging to see the UN acknowledge the risk associated with NCDs because it highlights the need for effective systematic health management, particularly of diseases with high prevalence that require continuous maintenance.  Failure to manage such a large portion of the pie that constitutes healthcare costs will have cascading effects on global and local economies.

Reform Rodeo

Photo by David Monniaux

1. Kaiser Health News discusses the details of the House’s latest iteration of their Health bill.

2.  Ezra Klein analyzes whether the public plan will cost insureds more than private insurance.

3.  The New England Journal of Medicine circles back to a reform issue that is often overlooked: primary care and accountable care.

4. Jonathan Cohn at The New Republic looks at how two of the biggest players in the U.S. health care system–the medical device industry and the pharmaceutical industry–are affected by the House bill.

5.  The Healthcare Economist reports on a study released by the Urban Institute that breaks down how the House Bill will affect the number of uninsured.

6.  Wild Card: Eugene Volokh highlights on a case involving one company’s desire to patent a physician’s thought process.

7. In Case You Missed It: The Cost of (Not) Implementing Chronic Care Management by Professor John V. Jacobi.

Reforming Medical Treatment for People with Serious Mental Illness

Photo by Maurizio Polese

What group could health reform help most?  The obvious choice (maybe the right one) would be people with no insurance, or lousy insurance.  It is clear that un- or underinsurance is bad for your physical and fiscal health.  How about people in need of skilled nursing care and assistance with activities of daily living?  Some provisions of pending bills would allow these folks to avoid the Hobson’s choice of institutional care or too little care.  But the cohort that might stand to gain the most from reform is the population of people with serious mental illness.

People with serious mental illness have long been known to have excess morbidity and mortality as compared to people without serious mental illness.  Although much of this excess is attributable to “unnatural causes” - e.g., suicide – studies have identified in this population substantially elevated natural causes of illness and early death from conditions such as cardiovascular and respiratory disease.    Some of these conditions are caused or exacerbated by side effects of newer atypical antipsychotics.    Much of this excess morbidity and mortality is preventable, and some causes (e.g., poorly controlled diabetes) could be addressed through sound chronic care management techniques I’ve described in an earlier post.    Inadequate attention to the management of the medical concerns of people with severe mental illness could be a particularly attractive goal of health delivery reform.

The National Association of State Mental Health Program Directors issued a Technical Report last year on this issue.  Its literature review rendered the following judgment:

Recent data indicates that, on average, persons with serious mental illness die 25 years earlier than the general population.  Eighty-seven percent of years of life lost to premature death are due to chronic disease, especially infectious, pulmonary, and cardiovascular diseases, and diabetes.  Cardiac events alone account for more deaths than suicide.

The data are emerging; more work needs to be done to evaluate comprehensively the connection between incidence of severe mental illness and lack of appropriate, coordinated medical care.  Whatever exact relationship is revealed, the situation is clearly dire: the fragmentation of our health care system causes particularly severe problems for people with serious mental illness.  The Association noted that emerging chronic care management techniques offer a way out of this unconscionable mess.  It advocates the adoption and application of patient-centered medical home programs that bring together primary care, mental health care, and care for chronic medical conditions in a patient- and community-centered environment.

The current bills offer some funding for such measures, at least as pilots.  The House bill, for example, contains language supporting Medicaid medical home demonstrations with initial funding tilted to the federal, in order to encourage states to try these programs out.  Let’s hope these and similar measures, which offer hope for the correction of terrible health disparities in a cost effective manner, survive the production of final legislation.

Employers Adopt Chronic Disease Management Programs

Photo by wwarby via Flickr

Kaiser Family Foundation reports another option for employers attempting to keep health insurance programs affordable.

KFF states:

“Eighty percent of large U.S. companies this year are offering chronic disease management programs for workers in an effort to reduce health care costs, up from 51% last year, according to a new survey by Hewitt Associates, the Houston Chronicle reports. Hewitt surveyed 343 large companies and found that more employers are targeting costly chronic diseases — such as diabetes, heart disease, asthma and depression — rather than workers’ eating or exercise habits. Hewitt estimates that a company with 9,500 workers and 500 retirees younger than age 65 spends between $18 million to $22 million on health care just for those with diabetes.”

Companies are managing chronic disease “by offering employees personal health coaches, on-site health clinics and copayment waivers for needed medications.”

Compared to consumer-directed health plans, chronic disease management is a relatively uncontroversial approach to lowering health care costs for employers.  As we’ve noted in a recent post, “Twenty-five percent of the U.S. community population were reported to have one or more of five major chronic conditions.” Not only does chronic disease management focus on preventative care and employees’ long-term health, employers are saving money in the short-term.  The results, although varying, are generally successful, with employers “spending 10% to 30% less per year on medical care after two to five years (Sixel, Houston Chronicle, 4/2).”  The short-term savings could lead to healthier employees, higher productivity and long-term savings.

The Houston Chronicle reports that:

According to Joseph Jasser, regional medical director for Houston for Concentra, an industrial medicine and urgent care provider, “If you can change their lifestyle — cut out smoking, eat better and exercise — then they’re healthier and companies end up spending less for medical care.”