“Epidemic” of chronic disease?

May and colleagues note that “chronic disease is the great epidemic of our times” reflecting the “epidemiological shift from acute disease, where the emphasis was on cure.”1

You could say that the emphasis shifted from dying from untreatable diseases to curing them and living to a greater age with incurable but manageable disease. A primary reason for an “epidemic” of chronic disease is not that so many more diseases are occurring but that so many more people are living with them rather than dying from something else.

Thus, the epidemic is largely a lot of people who would, according to old expectations and treatments, be dead. Suppose that many of the women who formerly died in childbirth now often lived but with an ongoing problem. Would we note the success of preventing their deaths, or bemoan the fact that there were so many women with birth related problems?

Both patients and healthcare providers would benefit in seeing chronic disease as the other side of not dying early. It is the “price” of a longer life for many. Some may choose not to be treated, at least for some things, with the recognition that this might hasten their deaths. Others might be more than willing to do whatever is necessary to prolong life.

But both require a dialogue between doctor and patient about what they are getting for the price of ongoing disease management and adherence to treatment.