Monday, April 23, 2012


Chronicity was the buzzword for last week's major global conference - the Geneva Health Forum. It is a term that encompasses the breadth of chronic health conditions, including the high profile non-communicable diseases (NCDs) such as heart disease, diabetes and cancer. This year's forum pulled together a wide range of participants from all over the world to consider how health systems can make a more substantial impact to stem the tide of chronicity facing those in both developing and developed countries.

40% of all mortalities are caused by NCDs. This should not surprise or shock us. After all, everyone has to die of something. If we are successful enough at keeping infectious diseases at bay, then it is likely to be an NCD that gets us in the end. We are not going to make any impression on the 100% mortality rate that we all face. However, many of these chronic diseases are affecting the young and middle aged. Two thirds of these cases could be prevented. One third can be treated.

Chronicity is something that requires a significant input of medical resources. The control of diabetes requires daily medication and regular check ups. Cancers and heart disease can be treated with ever more effective but expensive interventions. Where people are incapacitated for the long term, the burden of care is high. One calculation suggests that assuming current trends in both morbidity and treatment, the cost of health services in the United States will rise from its current unsustainable peak of 18% of GDP to an astronomical 40% by 2050. Clearly that is not going to happen. New approaches to the prevention and treatment of chronicity are essential.

This raises key questions. Chronic diseases are often related to lifestyles. The impact of proper exercise and diet regimes in prevention is by far and away the most significant. Yet people struggle to make the changes they need because of limits to personal self-discipline and the influence of social habits. Then there is the question of death. In countries with comprehensive health systems, the cost of care in the final 3 months can often exceed the sum total of all prior costs of care. The medical profession tries to meet our unrealistic expectations with huge inputs of treatment when there is little purpose in extending life. Death is too often perceived as a failure of care.

I have no doubt that the Church can offer a great deal to these conundrums; to promote prevention, to support the care of the chronically sick and to help find an appropriate setting and expectation for the end of life. These are dilemmas facing individuals, families and communities. Our healing vocation sits very squarely in this territory. We can help improve diets, help draw in more people to exercise opportunities and be present to care for those whose lives are blighted by long term chronicity.

Perhaps you have some ideas about this or experiences to share? Feel free to comment.


Wednesday, April 4, 2012

Life and Death

Holy week confronts us with the reality that some people have the power over life and death. Like Pontius Pilate they can be swayed one way or another. To take a life or to save a life? In the medical world, this is experienced most controversially in abortion. In some countries doctors are offered guidelines within which they are free to take the life of an unborn child. They use their professional judgement and ethical perspective to make this choice.

In another classic example, the state can exercise the power of execution. The life of a killer can be cut short as punishment for the crime. In Switzerland, there are two agencies that provide euthanasia services. The tools of self-destruction are provided to those whose will to live has expired. Though less directly involved, the choice is still negotiated with the agency. It's judgments influence who lives and who dies.

Beyond these very controversial examples are those regular decisions taken by doctors the world over. Do they let life slip away or do they intervene more aggressively to hold back the tide of death? Their professional and ethical training is designed to help them interpret the circumstances of an individual patient and to guide their actions for treatment or to assist a comfortable end.

This power over life and death remains in human hands, uncomfortable though that is. In many ways we now have more options and therefore more complex choices. Pilate recognised the political dangers of the dilemma before him and hoped for an alternative. Ultimately he was forced to choose: Jesus was hung on a cross. An eternal and divine injustice was committed. Choices cannot always be avoided.

Not many of us have to face dilemmas such as these, and even if we do, we have a natural instinct to save life rather than extinguish it. Yet death becomes us all. We see how profoundly people suffer in the fight to hold on to life until the bitter end and we realise that the power we have to intervene is not easily wielded. These choices haunt us even as they give many the hope of rescue.

There are no easy answers to these common dilemmas. The passion of Christ holds us this week in the grip of death. It is a story and a context we should embrace and from which we can draw spiritual strength for the times and choices that lie ahead.

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