Health leaders have called for a move towards prevention as new analysis reveals that one in five of the adult population in England will be living with a major disease by 2040.
In its report – Health in 2040: projected patterns of illness in England – the Health Foundation has projected that 9.1 million people will be living with major illness by 2040, 2.5 million more than in 2019. This will increase the proportion of adults living with disease from one in six in 2019 to one in five.
The increase is largely to do with increasing life expectancy, while the age at which people are expected to be living with major illness is projected to remain constant. This increases the time people are projected to live with major illness from 11.2 years in 2019 to 12.6 years in 2040.
Some 80% of the projected increase in major illness – two million people – will be among people aged 70 and over, as baby boomers reach old age, with the remaining 20% among the working age population. Some improvements in health, as a result of reduced smoking and lower cholesterol rates are expected to be offset by the impact of obesity.
The research also anticipates growth in illness related to anxiety and depression and diabetes. These are predominantly managed outside hospitals, and the Health Foundation said this reinforced the need for investment in general practice and community-based services and a focus on prevention and early intervention.
‘Over the next two decades, the growth in major illness will place additional demand on all parts of the NHS, particularly primary care, where services are already under extreme pressure,’ said Anita Charlesworth (pictured), director of the REAL Centre, the foundation’s long-term economic think tank. ‘But with one in five people projected to be living with major illness in less than two decades’ time, the impact will extend well beyond the health service and has significant implications for other public services, the labour market and the public finances.’
Layla McCay, director of policy at the NHS Confederation, said the findings suggested a worrying increase in pressure and demand for the NHS. ‘Health leaders are clear that more needs to be done to prevent people from falling ill,’ she said. ‘A greater shift towards preventative health and care services will save money in the long run, improve population health and reduce health inequalities.’
And Sarah Clarke, president of the Royal College of Physicians, said the projections would be ‘catastrophic’. ‘We know that much of this illness is avoidable – it’s caused by smoking, poor housing, unemployment, poor food and air quality, and obesity,’ she said. ‘It is in the gift of the government to do something about all these things.’
The Health Foundation said there were lots of important reasons to invest in primary prevention. By reducing the risk factors associated with ill health, such as stopping smoking and maintaining a healthy weight, the onset of many conditions would be delayed and those conditions could be easier to treat. But it was not clear if it would reduce the time spent in ill health as it could also increase life expectancy.
And while there is a lot of evidence that prevention is ‘hugely cost-effective’, this does not mean it will be cost saving. ‘It may be that a reduction in risk factors does not reduce prevalence because it boosts survival as well as delays onset, but that the costs of treating people are lower because they are healthier,’ the report said. ‘’Any reduction on in-year costs would be weighed against a longer life expectancy, which will tend to increase costs over the longer term.’
Technology will also have an impact on future illness levels. Improved diagnostics could mean earlier diagnosis, which could lead to reduced prevalence. But technology could also help to keep people alive longer, tending to increase prevalence. In cost terms, some technologies will be purely cost saving, helping the NHS to deliver the same service at a reduced cost. But in other cases, technology could lead to better outcomes at a higher cost or extend life, which might increase the total cost of treating a patient over their lifetime.
The report highlighted the earlier Topol review on technology, which said that new digital technologies were more likely to improve outcomes and experience rather than save labour. And it added: ‘Given the projected demographic shift, technology that can improve labour productivity will be ever more important.’
Most of the projected increase in levels of major illness by 2040 relates to changes in the size and structure of the population. Given this, the report said there was a limit to how much improvement in population-level risk factors and use of technology could contain costs. An overall increase in healthcare spending was inevitable. The key question would be how this was funded.
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