Chronic Illness

Patterns of health, sickness, and death differ dramatically among countries based on levels of economic development, health policies, and medical technologies. By the mid-1900s, people living in developed (industrialized) countries experienced a sharp decline in their incidence of acute, infectious illness and an increase in rates of chronic illness. The National Commission on Chronic Illness defines a chronic illness as having one or more of the following characteristics: It is long-term or permanent; it leaves a residual disability; its causes, natural course, and treatment are ambiguous; it is degenerative; it requires special training of the patient for rehabilitation; and it requires a long period of supervision. Examples of chronic illness include asthma, allergies, heart disease, diabetes, hypertension, stroke, cancer, cystic fibrosis, sickle-cell disease, varicose veins, arthritis, cirrhosis of the liver, renal disease, and mental illness. As these examples suggest, chronic illnesses range in severity from those that are relatively mild and can be controlled by medical therapies and changes in health behaviors to those that are severe, degenerative, and terminal, causing disability and creating the need for long-term, extensive medical care. Chronic illnesses, now the leading cause of death in industrialized countries, often develop gradually due to a combination of environmental, genetic, or social factors. In many cases, the specific cause of a chronic illness cannot be determined, and its diagnosis and treatment can be difficult. This shift in the disease burden from acute to chronic illness has several important consequences. First, it accentuates global disparities in health and wellbeing, as most people living in less-developed countries have shorter life spans and high rates of death from acute, parasitic, infectious, and/or poverty-related illnesses. Second, chronic illness challenges the assumptions of modern medicine which, based on the "germ theory" of disease, has focused on finding cures for short-term illnesses with clear causes. Finally, the rise of chronic illness has increased the role of families in providing care for their sick and/or disabled members and caused governments to reassess their health policies.