A GLOBAL HEALTH CRISIS
Social care and health care integration for a relevant response
By Tom Kirkwood, Chairman of AXA Research Fund’s Scientific Board
“As our populations age, we have to get better at dealing with multi-morbidity. We have made progress in this area, but not enough.”
In many ways, this crisis should not have come as a surprise. Although we had been talking about the risk of a major pandemic for some time, we had no experience of an event on this scale, the last example being the ‘flu pandemic that followed the First World War – more than a hundred years ago. The exception is Asia, whose experience with SARS in 2002-2003 has stood its governments in good stead.
While many Asian countries – particularly South Korea and Taiwan – reacted quickly to the COVID-19 outbreak, European countries were much slower in their response. There is, of course, a limit to how prepared countries can be for a pandemic like COVID-19. For instance, it makes no sense to stockpile respirators when you know nothing of the nature of the disease you might be facing. We should have been better prepared psychologically though. That way, we could have put our plans, or war games, more quickly into action. For many of us, it wasn’t until we saw the extent of the crisis closer to home – first in Italy, then, subsequently, in Spain – that we began to realize the seriousness of this situation.
Looking ahead, this crisis has shone a light on a number of very important questions: everything from how we organize our healthcare systems, to how we treat our older and more vulnerable citizens. It’s clear that the virus will be with us for some time since there is no immediate prospect of a vaccine. It is worth noting that most common colds are caused by coronaviruses, and we don’t have a vaccine against the common cold. Meanwhile with HIV, we’ve been searching for a vaccine for the past thirty years, and we still do not have one. Moreover, our healthcare systems have come under terrible strain, although overall they have held up impressively well, at least in terms of crisis response. It is safe to say that, over the longer term, we will have to live with this disease and we will simply have to adapt.
We also have to recognize that socio-economic factors have a role to play, since problems of multiple illnesses and conditions tend to come earlier in the lives of those who are socially disadvantaged. As we have seen, mortality rates among those with lower immunity – either age-related or because of pre-existing diseases – have been much higher than in the general population.
What is alarming is the number of people no longer seeking treatment for other serious illnesses. In the UK, for example, there has been a significant decline in referrals for possible early-stage cancer. In April, referrals for cancer were down 60% in England. It’s not only cancer – we are seeing similar patterns with other chronic illnesses like heart disease and diabetes. People falling sick earlier or dying younger than they would otherwise have done, because fear of COVID-19 has kept them away from hospitals and surgeries, may prove to be one of the unfortunate side-effects of this pandemic. As our populations age, we have to get better at dealing with multi-morbidity. We have made progress in this area, but not enough.
“What is alarming is the number of people no longer seeking treatment for other serious illnesses.”
“There is a clear case for bringing our healthcare and social care systems together. This was true before the pandemic. With COVID-19, the case has become stronger still.”
During this crisis, we have been at great pains to shield older people. Nevertheless, in some countries, with care homes, we got it badly wrong. In the UK, older people in hospital were returned to care homes even though, in some cases, they were carrying the infection. It’s not just the UK. We have also seen a shocking number of deaths from COVID-19 in care homes in other countries, such as Spain and Belgium. On the one hand, we were doing our best to protect older people by giving them priority for food deliveries, for example, or asking them to stay indoors. On the other hand, we were putting them at serious risk in our care homes. There is a clear case for bringing our healthcare and social care systems together. This was true before the pandemic. With COVID-19, the case has become stronger still.
Many of these issues cut to the heart of who we are – of how we balance the interests of younger and older people within society, of how we make sure we protect the less fortunate among us, or how we integrate older people more fully into our economies and societies, recognizing their worth as well as their vulnerability. These are not easy questions. Very often, our institutions resist change; there is always a temptation to carry on as before. But change has now become necessary. We must reconfigure our approach to health and social care. To do so, we will need all our determination and creativity.
Readers also read
- COVID-19 will accelerate the trend toward more online health, by Claudio Gienal
- “Stratify and shield”: a better approach to lockdown, by Professor Helen Colhoun
Chairman of AXA Research Fund’s Scientific Board and Emeritus Professor in Aging, Newcastle University (UK)
Until recently, Professor Tom Kirkwood was Newcastle University’s Associate Dean for Aging and Director of the Institute for Aging and Health in the UK. His research focuses on the science of aging and its relation to disability and disease, including the impact of social and behavioral factors. He has advised the UK government on population aging and is also currently affiliate professor at the University of Copenhagen Center for Healthy Aging in Denmark.