One of the greatest challenges that will face health systems globally in the
twenty-first century will be the increasing burden of chronic diseases (WHO
2002). Greater longevity, “modernization” of lifestyles, with increasing exposure
to many chronic disease risk factors, and the growing ability to intervene to
keep people alive who previously would have died have combined to change
the burden of diseases confronting health systems.
Chronic conditions are defined by the World Health Organization (WHO) as
requiring “ongoing management over a period of years or decades” and cover a
wide range of health problems that go beyond the conventional definition of
chronic illness, such as heart disease, diabetes and asthma. They include some
communicable diseases, such as the human immunodeficiency virus and the
acquired immunodeficiency syndrome (HIV/AIDS), that have been transformed
by advances in medical science from rapidly progressive fatal conditions into
controllable health problems, allowing those affected to live with them for
many years. They also extend to certain mental disorders such as depression and
schizophrenia, to defined disabilities and impairments not defined as diseases,
such as blindness and musculoskeletal disorders (WHO 2002), and to cancer, the
subject of a separate volume published by the European Observatory (Coleman
et al. 2008). While others have offered different definitions for chronic illness
(Conrad and Shortell 1996; Unwin et al. 2004), the common theme is that
these conditions require a complex response over an extended time period that
involves coordinated inputs from a wide range of health professionals and
access to essential medicines and monitoring systems, all of which need to be
optimally embedded within a system that promotes patient empowerment.