Managing chronic disease

All living things die. In nature, untrammelled, the common agents of death are trauma (being eaten is the commonest variety), deprivation, infection, and poisons.

Health for all is unattainable. A disease-free world is an illusion

Culture is to a large extent concerned with death. It tries to explain it; often it tries to present it as an event which is not final and rather promising. Nevertheless, culture makes immense efforts to postpone death.

Medical care is central to contemporary culture. Its importance is steadily growing because, for the first time in history, medical care has an impact. Life expectancy is increasing as the direct result of therapeutic rather than preventive and promotive activities. We have learnt to cure many fatal conditions, and we have learnt to manage chronic illness.

Life expectancy is looked on as a measure of civilisation, if not the principal index of cultural achievement. Yet long life can be mistaken for a sign of health. Until recently …