How do we break the chain of chronic disease?

4th June 2020

Isma Benattia, M.D., MBA, currently serves as the European Medical Lead for Amgen, one of the world’s largest biotechnology companies. Isma is very passionate about patient involvement in the research and development of innovative medicines and has over 20 years of industry experience across three continents.


Chronic diseases are a global challenge. They are steadily increasing every year due to lifestyle factors and our ageing population. Our lifestyles are also leading to the earlier onset of chronic disease, meaning that people are diagnosed earlier and have such diseases for longer. The longer a patient has a chronic disease, the greater the general impact both on the person and their families, and the healthcare systems who care for them. Complications associated with chronic diseases, such as cardiovascular disease in people living with diabetes, are also more likely the longer the patient has the condition.

One of the big problems we face in getting ahead of chronic disease is that many are largely silent – they creep up on people and impact their health even before they know they have it. In type 2 diabetes, for example, it is predicted that 50% of people living with the condition may be undiagnosed and therefore are not receiving effective intervention.1 Intervening early in chronic disease is key to overall outcomes – ideally, when the disease can still be prevented through diet and lifestyle.

But this is nothing new, we all know the statistics by now. So, given that we have the knowledge, what do we need to do to really make a dent in the chain?

Well, one issue is that we are not looking at it broadly enough. The challenge is much bigger than healthcare alone – chronic disease is a societal issue and therefore requires collaborative action of governments, city and town councils, healthcare, and industries such as food and drink. We often underestimate just how big a task this really is. Even something as small as reducing the salt in our bread would have a significant impact on heart-related conditions, however imagine the work that would need to go into implementing such a change. New policy and regulations would be needed to enforce company compliance with healthy salt levels, manufacturing and importing of goods would need to be considered to ensure supply from compliant sources, and citizens would need to be educated, informed and supportive of the move. And this is just one small change, imagine how much work would be involved if we embarked upon a series of changes to reduce chronic disease.

Another challenge is that we are very much on the back foot when it comes to chronic disease. Human habits are developed at a remarkably young age, as are taste preferences and food related cravings or addictions. These are all hard to break once formed, and we need to intervene much earlier to set the right habits in school age children – educating them about healthy habits including exercise, nutrition, and making them aware of chronic diseases. Once habits are formed it takes significant levels of intervention in order to see benefits, for example, we only saw smoking reductions at large scale when smoking bans were introduced.

The rewards of adopting early and significant intervention to reduce the impact of chronic disease are way in the future. Making changes to the way we deal with chronic disease will not have an immediate and vast impact, and the benefits of a changed society will only be felt in one, or even two, generations’ time. Therefore, it must be a long-term government initiative, as no individual player can do this alone. Many healthcare services across the EU are still spending a tiny portion of healthcare budgets on prevention of chronic diseases. Given the current strains on healthcare resources, it is understandable why we’re in this situation as there are so many patients with ill health that require treatment now, and hence often our resources are directed to the immediate “fix”/need.

This is the case now more than ever with the global pandemic putting additional strains on already tight healthcare resources. Like others in our sector, Amgen is seeing varying degrees of impact from COVID-19 as clinician-patient interactions are interrupted. These reduced interactions have led to some delays in diagnoses or interruptions of existing treatment. We are seeing increased public health concerns that complications of these chronic diseases will worsen.

Unfortunately, no health service is going to recognise the immediate benefits of investing in prevention, particularly in this current environment, and this is why government intervention at a population level is necessary. We, as a society, will all benefit in the future from investing in prevention now. There are a number of intervention programmes that have demonstrated impact. For example, the Amgen and EIT Health programme #ProtectUrLife, which has been running since 2018 has demonstrated impact in educating citizens in cardiovascular and bone health. Last year, the screening and educational initiative was delivered in five locations across Europe and found that around a third of the people we saw were at risk of osteoporosis or cardiovascular disease. A large majority of the people we saw said that they felt more educated and were motivated to lower their risk and see a doctor.

Frustratingly, when people talk about chronic disease, it is often seen to be the individual’s fault; the person who has the disease did not eat healthily or exercise enough. In fact, the healthcare eco- system didn’t intervene and educate the population at the right time. Beating chronic disease is not about one individual, or even one individual sector. Alone, we can only make a minor difference, but together we can make a big difference.