There’s an interesting and thought-provoking article in the BMJ last week about health promotion and a call to tackle the ageing process.
The traditional medical approach to ameliorating modern chronic diseases has been to tackle them individually, as if they were independent of one another. This approach flows naturally from our experience with acute diseases, where patients seek medical care for one condition at a time. In fact, applying this same strategy to infectious diseases in the 20th century helped to deliver the first longevity revolution.4 Although some infectious diseases have chronic effects on health (such as malaria and HIV infection), and others remain difficult to treat (including tuberculosis and most viral diseases), public health efforts to combat these diseases have made it possible for people in today’s developed nations to live long enough to experience one or more of the degenerative and neoplastic diseases that are now the dominant causes of morbidity and death.
The phrase which really struck me here is the last one – “public health efforts to combat these diseases have made it possible for people in today’s developed nations to live long enough to experience one or more of the degenerative and neoplastic diseases that are now the dominant causes of morbidity and death.” Think about that for a moment. Yes, there have been great advances in human health and life-expectancy has increased dramatically (mainly due to the reduction in infant and child mortality), and, yes, the ability to effectively treat so many potentially fatal infections has played a significant role in improving human health. But what we have now is more people living long enough to experience a serious chronic disease. So what are we going to do about that? The authors argue this –
Medical research worldwide has already accomplished much, and is certain to achieve more in decades to come, but its effectiveness will become limited unless there is an increased shift to understanding how ageing affects health and vitality. Most medical research teams are oriented towards the analysis, prevention, or cure of single diseases, despite the fact that nearly all of the diseases and disorders experienced by middle aged and older people still show a near exponential increase in the final third of the life span. Now that comorbidity has become the rule rather than the exception, even if a “cure” was found for any of the major fatal diseases, it would have only a marginal effect on life expectancy and the overall length of healthy life
I would disagree a bit – in fact, I don’t think ageing is the issue, it’s health. I think we don’t so much need to understand how ageing affects health and vitality as to understand how health and vitality affect ageing! It’s true that so much of contemporary health care in focused on treating single diseases and disorders (in fact almost the entire evidence base of “evidence based medicine” is clinical trials conducted on individuals with single conditions), but it’s also true that “comorbidity has become the rule rather than the exception”. That’s such an important point to take on board. We will NOT have any significant further improvement on health and longevity by focusing on single conditions and diseases.
Instead, we need to focus on health and vitality. It’s well known that exercise and nutrition contribute enormously to both of these and some commentators on this article have made that point well.
What I take out of this article however is this – if we want to significantly improve health and longevity we need to focus on HEALTH not disease and we need to take the policy decisions to target health improvement if we are to reduce the burden of suffering and illness.