The World Health Organization (WHO) was among the first to alert the public authorities of a growing phenomenon in all countries, developed and developing, chronic disease. These diseases cover a very broad class of health problems that can appear seemingly disparate. “Communicable diseases (HIV / AIDS) and non-communicable (cardiovascular diseases, cancer and diabetes) persistent, certain mental disorders (depression and schizophrenia), and permanent physical disabilities (amputations, blindness and joint disorders), s’ they may look different, all fall into this category “(WHO, 2003, p.11). They feature “beyond their time by the magnitude of their impact on daily life not only for patients but also for those around them. This upsets everything from health to quality of life, friendships to family life, recreation to professional life. Their common is they sound systematically on the social, psychological and economic dimensions of the patient’s life “(WHO, 2005, p.15).
A comprehensive definition of chronic diseases is proposed in a dictionary. These diseases are one or more of the following characteristics: they are permanent, they leave residual disability, are caused by an irreversible alteration, they require specific education through rehabilitation, they may require a long period of supervision, observation or care (Timmreck 1982).
Those chronically ill account for about one third of the general population, or 20 million in France for example. Chronic diseases constitute 77% of diseases, the most important are the cardiovascular, cerebrovascular, respiratory, metabolic and cancer (Mladovsky et al., 2009). In 2002, these diseases caused 86% of the 9.6 million deaths in Europe. They are also responsible for 70% of health spending (WHO, 2008).
Chronic diseases usually result from environmental causes. In English, they are also called “non-communicable disease” which reflects the important role of deleterious health behaviors such as physical inactivity, smoking, alcohol abuse or poor diet. They are sources of new problems of health, comorbidities (Bousquet et al., 2011), which make them complex and systemic effects (De Ridder et al., 2008). The therapeutic challenge for patients is much better to live with the disease than winning at all costs days of life.
Schematically, their trajectories are different:
(1) stable disease changed little over time with treatment with life, with surgery and/or other medical devices
(2) degenerative disease where health gradually deteriorates (e.g., neurodegenerative dementias and cancer at an advanced stage)
(3) the disease progresses in fits and starts, with decompensation or pushing (e.g., multiple sclerosis)
(4) the disease progresses in crisis phase or exacerbation (e.g., chronic obstructive pulmonary disease).
The therapeutic logic Louis Pasteur is not applicable to chronic disease. Be based on the idea that it is necessary to identify the cause that causes disease and to understand the mechanism for finding biological treatment leads to healing and symptom resolution is irrelevant. A chronic disease, by definition, is multifactorial and not curable (or non-reversible). Therefore, it requires a different view of the acute disease whose signs are obvious and sudden onset and known changes. Signs of onset of chronic disease are insidious. Its evolution is progressive, unpredictable and not fully reversible. Pain and disability situations persist. Chronic illness forces patients to work closely with health professionals, to think and tertiary prevention to rethink their lifestyles.
Chronic disease causes over time implications that go well beyond the damaged organ or disturbed function. Complications following the disease and/or treatment, also known as co-morbidities appear. New diseases and new health problems emerge. This damage also affect the psychosocial aspects. This makes it difficult to disentangle the various factors. The cause becomes a consequence and vice versa. One example is the “cycle of physical deconditioning and psychosocial” (Prefaut and Ninot, 2009).
Health professionals may consider that a chronic stable disease when treatment can rebalance the main biological parameters in their target areas. But from the perspective of the patient or of others who live daily with the disease, it is often not the case. Persistent pain, incomprehensible events, temporary difficulties worrying signs make life very unstable patients (Ninot et al., 2010). Many symptoms are variable over time. This instability reflects a real vulnerability that requires great listening on the part of the patient, his entourage and professionals.
Entanglement of genetic, behavioral and environmental factors makes unpredictable changes in the health of a chronically ill patient. Factors work together to influence health. Add to this the effects of aging. Authors now plan to understand chronic illness as the result of a complex system where most of causality would be nonlinear (Frey and Suki, 2008).
The support of people with chronic disease
Patients with chronic conditions require coordinated care over time and take into account their needs, values and preferences. They need to be taught how to self-manage to prevent complications and caregivers understand the fundamental difference between a temporary illness is diagnosed and treated and a chronic condition that needs to be managed over many years (WHO, 2003, p.19). Blog in Health will use the term supplementary and not care to emphasize the active, informed and responsible nature of the patient and as health professionals.
What it means for Patients
Chronic diseases, in contrast to acute diseases do not require emergency care. They represent nearly a third of the French population, or 20 million people. The main ones are cardiovascular, cerebrovascular, respiratory, metabolic and cancer. They are due to risky behaviors such as physical inactivity, smoking, alcohol and/or poor diet. They are often diagnosed late, after symptoms are important and that biological damage is significant. If left unchecked, these symptoms will not accumulate, they will multiply and will weaken irreversibly ill.
What it means for Health Professionals
Chronic diseases are the result of risky behaviors (physical inactivity, smoking, alcohol, poor diet…). The therapeutic and preventive challenge is to help patients live better lives, not just their disease increase at all costs their life. Unlike acute diseases where almost everything is decided by the physician in light of the urgency of the situation, chronic diseases require health professionals to work with patients, to “negotiate” some particular choice regarding the prevention and change of lifestyle. This type of exchange is appointed by the World Health Organization therapeutic alliance.
What it means for Researchers
77% of the diseases do not heal. The best known are the cardiovascular, cerebrovascular, respiratory, metabolic and cancer (Mladovsky et al., 2009). In 2002, these diseases have caused in Europe 86% of the 9.6 million deaths. They often result from risky behaviors such as physical inactivity, smoking, alcohol and poor diet. They are called non-communicable disease in English. They are sources of new problems of health, comorbidities (Bousquet et al., 2011), which make them complex (Frey and Suki, 2008) and systemic effects (De Ridder et al., 2008).
What it means for Policymakers
A third of the general population suffers from chronic disease, 20 million people in France. The most important chronic diseases include cardiovascular, cerebrovascular, respiratory, metabolic and cancer (Mladovsky et al., 2009). In 2002, these diseases have caused in Europe 86% of the 9.6 million deaths. They are also responsible for 70% of health expenditures (WHO, 2008). They often result from risky behaviors (physical inactivity, smoking, alcohol, poor diet …). Prevention is as important for those that care pathologies.
Bousquet J, Abdelhak S, (…), Auffray C (2011). Systems medicine and integrated care to combat chronic noncommunicable diseases. Genome Medicine, 6, 43-46.
De Ridder D, Geenen R, Kuijer R, van Middendorp H (2008). Psychological adjustment to chronic disease. The Lancet, 372, 246-255.
Fabbri LM, Luppi F, Beghé B, Rabe KF (2008). Complex chronic comorbidities of COPD. European Respiratory Journal, 31(1), 204-212.
Frey U, Suki B (2008). Complexity of chronic asthma and chronic obstructive pulmonary disease: implications for risk assessment, and disease progression and control. The Lancet, 20(372), 1088-1099.
Mladovsky P, Allin S, Masseria C, Hernández-Quevedo C, McDaid D, Mossialos D (2009). Health in the european union: trends and analysis. Copenhagen: The European Observatory on Health Systems and Policies.
Ninot G, Delignières D, Varray A (2010). Stability of physical self: examining the role of chronic obstructive pulmonary disease. European Review of Applied Psychology, 60, 35-40.
Préfaut C, Ninot G (2009). La réhabilitation du malade respiratoire chronique. Paris: Masson.
Timmreck T (1982). Dictionary of Health Service Management. National Health Publishing.
World Health Organization (2003). Adherence to long-term therapies: evidence for action. Geneva: WHO Edition.
World Health Organization (2006). Working together for health: The world Health Report. Geneva: WHO Editions.
World Health Organization (2006). Preventing chronic disease: a vital investment. Geneva: WHO Editions.
World Health Organization (2008). 2008–2013 Action plan for the global strategy for the prevention and control of non-communicable diseases. Prevent and control cardiovascular diseases, cancers, chronic respiratory diseases, diabetes. Geneva: WHO Edition.
To reference this Blog en Sante © article.
Ninot G (2014). Définir la notion de maladie chronique. Blog en Sante, L3.
© Copyright 2014 Grégory Ninot. All rights reserved.