Kieron Boyle, Chief Executive, Guy's and St Thomas' Charity
Sep 19, 2017
In Lambeth, just one person out of every five people who has diabetes only has diabetes.
That is to say, living with many long-term illnesses - chronic conditions like hypertension, coronary heart and kidney disease - is increasingly the norm. Less and less is the question about how do you deal with one condition in isolation, but rather how do you deal with a number at a time, often which interact in complicated ways.
And we believe this has quite profound implications for how all of us should be thinking about health.
Multi-morbidity is one of the biggest emerging health challenges in the UK. That's for three reasons: because of cost, because it's poorly understood; and because it is unequally distributed.
Tackling long-term conditions makes up for 70% of all NHS spending in England. In Lambeth and Southwark, the average cost to the NHS of treating somebody with one long-term condition is £2,000. The average cost of treating somebody with five long-term conditions is £21,000. And that's just the cost to the NHS; not employers, families or other statutory services.
Second, and more troubling still, it is not well understood. By way of comparison with another complex health issue we focus on - childhood obesity - multiple-long term conditions has has less than 20 really high quality international research studies. Childhood obesity has well over 100.
Third, and what is perhaps most motivating about this issue, is that it is unequal. We know that in Lambeth and Southwark, people in the poorest areas are developing long-term conditions at least 10 or 15 years earlier than people in richer areas. And once they do, they progress more quickly from one condition to multiple conditions. Black and minority ethnic communities, and those suffering from poor mental health, are also disproportionately affected.
So what can even one of the largest place-based foundations do about this? Well, much more in partnership than we can achieve alone.
We hope to connect with partners who can help us build the evidence-base on what works in improving the lives of people with multiple long-term conditions. Our programme model suggests to us this will require four things:
So: not a small challenge, but a crucial one, and an area we will be focusing on for many years.
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Erica Levine from the Arnold Institute for Global Health writes about our learning partnership, comparing efforts in improving health in New York and London.
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We asked some of the international experts speaking on at our joint event with the King's Fund what actions must happen today to make sure that future health in cities is equitable and thriving.
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Improving population health in towns and cities requires both an overarching city-wide strategy and a granular understanding of the needs of local neighbourhoods, as Chris Naylor and Kieron Boyle explain.