Degenerative. I’m not very fond of this word. Mostly because parts of me are degenerating at an alarming rate. But also, because it implies progressive deterioration, pain and un-treatability. For instance, if I diagnose osteoarthritis most patients assume that nothing can be done about it. This is not necessarily the case, but it is true to say that we are long way from finding a way to reverse degenerative processes. And there is a particular issue around ACC. I don’t know how many patients I’ve had who sustained an injury but were denied surgery under ACC because it turned out that their shoulders or neck or back or hip had some pre-existing wear and tear in it.
Actually, while I’m venting, I would observe there is a built-in unfairness in our medical system related to back pain. If this is covered by ACC the patient gets the benefit of a good chunk of their usual income, plus active case management and access to free specialist care in private. If it is not ACC, the income source will be the sickness benefit and one has to plod through the delays and inconveniences of the public system, which has strictly limited resources in this area. So, nobody’s fault, but I’m surprised that somebody in the health advocacy sector hasn’t made more fuss about this. Maybe it’s time for ACC to take over management of all forms of community rehabilitation, regardless of cause?
But coming back to degeneration, it is clear that in the future processes related to ageing will dominate health strategies. Since we have made dramatic progress in public health and infection control, what we’ve got left is things that gradually and chronically lead to pain, disease and disability. So, we could include diabetes, coronary heart disease, dementia, arthritis, osteoporosis and so on.
Since these are by their nature long term conditions, with multifactorial causes, there has to be a major change in how we manage them. The important things are:
- Health literacy and education. The patient must understand what is wrong with them and how to self-manage.
- Low cost interventions. We can’t keep throwing money at expensive drugs and procedures for everybody. Lifestyle changes are generally cheap, but they require buy in and empowerment for the person affected.
- Enhanced community support. Helping people to live happily and safely in their own homes is almost always the best option, until residential care is unavoidable. The more we can do for people in their local area, the better.
- A major investment in mental health and wellbeing. Besides reducing the impact of mental illness, there is no question that emotionally well people tend to make better decisions about their health and cope with illness and disability more successfully if it occurs.