Facing Up to Chronic Disease
MONTREAL – Many of us are terrified by the prospect of having a debilitating stroke or a fatal heart attack. Few of us, however, respond as emotionally to the threat of chronic disease, a vague and elastic term that is mainly useful for organizing health services. And yet chronic disease has become a major social problem that requires a collective response.
Historically, chronic disease referred to conditions lasting over a long period. But, with the increasing organization of medicine around specific diseases, the term has come to refer to an open-ended set of conditions including cardiovascular disease, cancer, and diabetes, but not infectious diseases, such as tuberculosis and malaria, or mental illness.
In the nineteenth century, chronic disease was considered problematic in part because sufferers took up scarce beds in hospitals that were increasingly focused on treating acute, curable diseases. But chronic disease soon became a wider public-health issue as the death toll from cancer, cardiovascular disease, and diabetes seemed to rise. In fact, the initial increase in the number of reported deaths from these diseases most likely reflected better identification and diagnosis. Filling in death certificates is not an exact science, and doctors focus on causes with which they are familiar.