A new normal? Non-communicable diseases after Covid-19
Former Chief Executive of the British Heart Foundation, Simon Gillespie OBE, stresses that as we recover from Covid-19, the UK must address the underlying health issues that have left millions acutely vulnerable to coronavirus.
In late May 2020, the UK began the process of ‘unlocking’ the Covid-19 lockdown. The toll of this disease, directly on those who have died or suffered, or the many who have made sacrifices to care for and support them, will be deep and will be long-lasting.
We now have an opportunity, to build not just on what was learned in the height of the crisis but also to reflect on the world before Covid-19. There are significant underlying health and care issues that have not gone away.
The NCD epidemic
Before Covid-19, the UK had seen a general decline in mortality from many non-communicable diseases (NCDs). This welcome trend was often in counterpoint to a rise in the numbers of people living with disease, and the impact on their lives and those of their families. Indeed, as we have become better in keeping people alive, more people are living with multiple underlying conditions.
In 2019, across the UK there were approximately 7.5 million people with a heart or circulatory condition, over 2.5 million people living with cancer and 4 million people with diabetes. We had also become more sharply aware of the importance of psychological health and well-being, and the interplay between them. Further, we now know the significant impact of inequalities on health outcomes. Over the past decade there have been some key policy changes, for example standardised packaging of tobacco products in the UK, but the decade had also seen stringent austerity and deep cuts, for example to public health investment.
The UK has been grappling with epidemics of NCDs for decades; and these challenges are global ones. In 2015, NCDs accounted for 40 million of the 56 million deaths worldwide. As the World Health Organisation observe, “this invisible epidemic [of NCDs] is an under-appreciated cause of poverty and hinders the economic development of many countries. The burden is growing – the number of people, families and communities afflicted is increasing.” (https://www.who.int/gho/ncd/en/ – downloaded 27 May 2020).
It is evident that Covid-19 has a disproportionate impact on those with previous health conditions – so the UK’s starting point at a population level in dealing with the pandemic was not a good one.
What routes should we take?
Cuts to public health on the level seen in the UK over the last 10 years are dangerous – whether in handling an epidemic of NCDs in the longer-term or enabling a shorter-term response to a pandemic. We should ‘hope for the best’ but we need to ensure we properly and effectively ‘plan for the worst’. Investment and insight are needed to construct effective mechanisms that truly promote a long-term view of the physical and psychological health and well-being of the UK’s citizens – both in the face of NCDs and in response to infectious disease.
Reliable and timely data is key to recognising both the emerging threat and identifying the key points. A clear example of the UK’s failure to harness this lies in the lack of data from care homes and the community for those early, critical, weeks of the pandemic. Policy makers and leaders were then in a position of making decisions based on incomplete data.
The care sector also was one of a number of ‘blind spots’ in a fragile health and care system but there are wider shortcomings. For example in the stumbling arrangements to engage with industry to exploit modern logistics or to ramp up production of key goods such as PPE, or the non-profit sector to increase volunteering to meet social needs or refocus research or care services.
Necessity has shown that many patients and clinicians are able to deal with new approaches to health and care in a way many were previously sceptical. We do not yet know for certain what people’s attitudes to these technologically enabled engagements are, or the health outcomes of them, but we should use the opportunity to speed up innovative approaches to deliver more convenient, patient-focused care.
Finally, people have been reluctant to attend medical facilities if they have a problem or concern, and our ability to reach out to the more vulnerable has been severely curtailed. ‘Normal service’ seems months if not years away, so we will reap the longer-term harvest of missed short-term opportunities: for early detection and treatment of cancer and heart and circulatory disease; for significant deterioration in mental health; for the support of at risk children and adults.
Learning from a crisis
We have an opportunity to ‘build back better’ in our preparations for further pandemic challenges and in ways that transform the breadth and depth of our health and care arrangements. Against a background of amazing and selfless commitment from many, we have seen some brilliant examples of improvisation and innovation. A crisis, by its very nature, is something major that was not planned for, so there will always be elements of dealing with the unexpected. That is why the response of individuals is so important and why we need to seize the opportunities from their creativity and commitment. Returning to ‘business as usual’ should not be an option.
As we begin to learn the lessons from Covid-19, we should mourn those who died as well as celebrate the individual and collective effort of our response. We must use this experience to change not just the mechanics of our crisis management but our approach to physical and psychological well-being, health and care.
We do not yet know what the next challenge will be, so we need to change in ways that focus on people and patients through investing more in how we enhance the health and well-being of the public in UK. We must also focus more sharply on health and well-being data and intelligence with trigger points for both communicable and non-communicable diseases.
The breadth, reach, resilience and flexibility of our crisis management arrangements internationally, nationally and locally must be secured – ensuring no key sectors are ignored or marginalised. This should be driven through a strengthened sense of collaboration, both internationally, nationally and locally that truly focuses on the needs of people across organisational and budgetary boundaries, using technology and new methods of working in the process. Further, we must develop the ability to maintain the health and care system continuing safe and effective services for the elderly, chronically ill, vulnerable, or acutely ill while dealing with the immediate challenge of a pandemic.
As we begin the process of recovery from Covid-19, we should re-focus on and refresh our approach to, the often unrecognised, large-scale and long-standing epidemic of non-communicable diseases that continues to blight the UK and the rest of the world.