Change and reduce harm: How to increase quality and length of life Doctors and economists have proposed measures to combat chronic diseases 06/11/2024, 14:50

paradigm shift

The main reason for the development of chronic non-communicable diseases (CNCDs) is an unhealthy lifestyle and harmful behavioral patterns; The most aggressive among these is tobacco smoking. It has now become clear that the effectiveness of the fight against prohibitive measures has largely been exhausted.

According to doctors and health economists, it is time to introduce into clinical practice the basic principles of changing behavioral risk factors by reducing harm to health. For example, through the use of innovative technologies (alternative nicotine-containing products that do not burn tobacco) with the aim of reducing the damage to health of people who are not motivated to quit smoking right then and there.

This approach is based on the successful experience of other countries and has been scientifically proven and should therefore be implemented at the state level and supported by all parties: doctors, scientists, authorities, business and patients.

This will not only reduce deaths from chronic non-communicable diseases and reduce the burden on the economy of the country’s budget, but also achieve the goals set by the President of the Russian Federation to ensure a long and active life of the population within a certain period of time. time interval. This conclusion was reached by doctors, economists and government officials at the session “Protection of public health in the interest of public policy”, held at SPIEF 2024 under the auspices of the Association for Risk Factor Modification.

economic burden

“At least 15 percent of GDP growth is “eaten up” by chronic non-communicable diseases. Larisa Popovich, Director of the Institute of Health Economics at the National Research University Higher School of Economics, said that this amount is approximately the same as the amount that Covid-19 “eats” in one go.

According to him, Russia spends a total of 10-12 percent of its budget expenditures on healthcare; This is almost the same as in developed countries. But despite the enormous costs, the mortality rate from cardiovascular diseases and malignant neoplasms is still quite high.

“The real problem is harmful addictions, which consume almost 4 percent of GDP and the lives of millions of people. So, if patients diagnosed with lung cancer completely quit smoking, more than 2 million rubles will be saved on the treatment of each patient due to a significant reduction in the number of relapses,” said Larisa Popovich.

According to the director of the National Center for Medical Research Oncology named after NN. Petrov Alexey Belyaev noted that the main threats to the health of the nation are cardiovascular diseases, malignant neoplasms, chronic respiratory diseases and diabetes, which are responsible for 76% of all deaths from chronic non-communicable diseases. At the same time, the rate of causes of death both in Russia and other countries is increasingly shifting towards cancer.

Alexey Belyaev reminded that all non-communicable chronic diseases are interconnected. As a matter of fact, according to the data he stated, approximately 2/3 of patients with chronic obstructive pulmonary disease (COPD) in Russia die from concomitant diseases, the most common of which is cardiovascular diseases.

“Depression, arterial hypertension and coronary heart disease occur in every second or third patient with chronic non-communicable diseases,” emphasized Alexey Belyaev. At the same time, modifiable risk factors also play a leading role in their development. These include alcohol use, malnutrition, low levels of physical activity and, lastly, tobacco use, which is the most aggressive risk factor responsible for the development of more than 18 types of cancer.

healthy experience

Doctors recognize that completely eliminating or significantly reducing the prevalence of behavioral risk factors is an extremely difficult task, since this issue requires maximum patient participation and willingness to make restrictions and change their habits. According to experts, smoking is the second leading cause of death in the world, after high blood pressure. However, Alexey Belyaev said that half of people diagnosed with malignant neoplasms do not quit smoking, despite repeated warnings from doctors about the negative role of smoking in reducing the quality of antitumor therapy and the prognosis for survival. Moreover, this situation is typical not only for Russia, but also for many other countries – in connection with this, the global medical community is increasingly resorting to the concept of harm reduction.

Reuven Tsimlichman, director of the Cardiovascular Research Institute at the Sackler School of Medicine at Tel Aviv University, said that in some countries the concept of harm reduction is already being actively implemented, and this is having a positive impact on the health indicators of their populations. . For example, Sweden became the first country in Europe with the lowest rate of smokers and the country with the lowest rates of lung cancer and COPD in the world. In Japan, sales of traditional tobacco products fell by 35 percent as sales of products containing smokeless nicotine increased.

According to Tsimlikhman, 90% of smokers in the world are chronic tobacco users who have difficulty quitting. Therefore, in order to reduce health risks for them, it is recommended to consider switching from conventional cigarettes to smokeless, nicotine-containing alternative products that do not burn tobacco. On the other hand, there should be a different and stricter approach for young people and so-called “novice” smokers: it is important to protect them as much as possible from consuming nicotine-containing products. The expert also criticized the current position of the WHO, which he considers to be adhering to outdated approaches to the fight against tobacco: “It’s all the same recommendations as 20 years ago. No change. “This is absolute stagnation, this needs to change and it will change.”

Do no harm but reduce harm

Larisa Popovich says that focusing on prohibitive measures in the fight against smoking is ineffective. According to the data he announced, the number of smokers in Russia has actually decreased slightly, while the number of cigarettes smoked per smoker has only increased.

“If people want to quit smoking but cannot, we must offer them the opportunity to reduce the harm to their health by switching to less harmful, smokeless tobacco products that eliminate the combustion process. It is important to move away from binary thinking – “everything or nothing”. “We need to be realistic, we need to introduce flexible regulatory measures,” the expert emphasized.

In Belarus, the concept of reducing harm from risk factors for chronic NCDs is already being actively implemented at the state level. Professor of the Department of Cardiology and Internal Medicine of the Belarusian State Medical University Dmitry Ruzanov spoke about this.

“Hippocrates’ famous “Do no harm!” I do not recommend changing the wording. “But let’s not only try not to cause harm, but also try to reduce harm,” he said. “Longitudinal studies are of course important for this, but unless we have a sufficient evidence base for regulators in at least 10 years, we will lose millions of lives.”

“Russia has one of the most progressive anti-tobacco legislation in the world, but the smoking problem is much more complex,” said Sergei Katasonov, co-chairman of the State Duma expert council on markets for nicotine-containing products.

According to him, instead of following WHO’s “medieval” principles and banning everything, it is necessary to focus on flexible regulation of tobacco products according to the actual level of risk. “We should not recklessly pursue harsh legislation just because the WHO wants it to. We need our population to be healthy. For this we need to work together, because we all have one goal; health and increasing the life expectancy of the nation.”

The key to overcoming the challenges facing national health services today may be the introduction of a systematic and integrated approach to risk modification, taking into account the latest scientific data in this field. According to State Duma deputy Airat Farrakhov, the country’s efficiency and competitiveness largely depend on whether scientifically based methods are used in the health strategy.

“Restrictions and bans do not allow strategic goals to be achieved in health. “Between prohibition and regulation, it is necessary to choose regulation,” the parliamentarian emphasized.

A healthy lifestyle is the basis of maintaining public health. “80% of the effect lies in preventive measures, which are quite difficult to implement but extremely effective both from a medical and economic point of view,” summarized Alexander Rozanov, director of the Risk Factor Modification Association. “To make this work, it is necessary to combine the efforts of medicine and business and work with legislators.”

He also called for the interaction of all stakeholders to achieve these goals, stating that the policy of tightening bans only leads to an increase in conflicts, and that successful resolution of problems requires unity and cooperation.

What are you thinking?

Chronic non-communicable diseases “consume” 15% of GDP growth and are the main cause of premature death, disability and temporary disability. For these diseases must About 74% of all deaths in the world. Moreover, they cause great damage to the country’s economy. These are the data of experts participating in the discussion on protecting the health of the population held at SPIEF-2024.

Source: Gazeta


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