Why CHRONEX-RD? Motivation of the project
Chronic diseases are pervasive globally and their prevalence is increasing
worldwide. The report issued by the World Economic Forum and the Harvard School of Public Health (2011) shows that chronic) diseases (hereinafter CD) are a significant threat to human health and economic growth. They are currently the world’s main killer being responsible for 63% of all deaths. Eighty percent of these deaths occur in low- and middle-income countries. Half of those who die of chronic diseases are in the prime of their productive years, and thus, the disability imposed and the lives lost are also endangering industry competitiveness across borders. According to the same report, over the next 20 years, CDs will cost more than US$ 30 trillion, representing 48% of 2010’s global GDP, and pushing millions of people below the poverty line. The rise in the prevalence and significance of CDs is the result of complex interaction between health, economic growth and development, and it is strongly associated with universal trends such as ageing of the global population, rapid unplanned urbanization and the globalization of unhealthy lifestyles. They also cause decreased productivity in the workplace, prolonged disability and diminished resources within families.
The Regional situation is briefly described in Table 1 below.
|CD situation ⁄ Country (valid for 2010)||Romania||Moldova||Ukraine|
|Total CD deaths (000)||226.5||39,3||648,9|
|CD deaths under age 60 as percent of all CD deaths||16,9%||24,8%||20%|
|Proportional mortality (% of total deaths, all ages)||91%||87%||86%|
|Has an integrated or topic-specific policy / programme / action plan which is currently operational for:|
Table 1 WHO Organization – CD Country Profiles (comparative situation)
Although, as shown in the table, there are no significant variations in terms of the magnitude of the problem of and national approaches to chronic diseases in these tree countries, there is no regional cross-border collaboration of the management of national health systems to develop common unitary and cost-effective public health interventions.
Regional problems addressed by CHRONEX-RD
Economic problem – The burden of chronic diseases falls disproportionately on socially disadvantaged people. Although the scientific advances led to the exponential increase of the number and complexity of the prevention, diagnosis, monitoring and treatment technologies for CDs, the diffusion of hi-technology health care has accentuated the social health inequalities attributable to CDs. This is so because the increased costs of these technological developments made them accessible mainly to people belonging to upper social spectrum. Our project has the potential to mitigate the social inequalities in health. There is evidence that integrated multidisciplinary care of CDs reduces the cost of care (decreased number of medical errors, decreased redundancies, etc.) and, thus increasing the access to care especially for socially disadvantaged people.
Social problem – CDs impose a significant economic burden. They generate loss of the work capacity of different degrees of severity with a negative impact on the workforce and the labour market. The time lost for treatment and care of chronic conditions represents a net economic loss for patients as well as time dislocated from other activities (relative loss) for health care professionals. In addition, the treatment and care of CDs also incur significant costs to the health care system. Nonetheless, societies burdened by higher levels of morbidity and mortality are less attractive for foreign direct investments, having a relatively lower economic competitiveness. Our project could mitigate the economic burden of CDs because it creates the premises for cost-effective health research and health care. Once established CHRONEX-RD could produce economic development by promoting:
- Cost-effective health interventions targeting chronically-ill patients: Evidence shows that integrated multidisciplinary health care and research produces direct economic gains through: improved health especially during productive years, lower costs for diagnosing, treating and recovering from diseases and productivity and process improvements in health care. There are also indirect economic gains through: lower production losses due to healthier workforce, economic growth and expanded knowledge base. Nonetheless, CHRONEX-RD will avoid inter-country redundancies, reducing the costs, while benefiting equally all involved countries.
- The expertise of the health care and research professionals, which will increase the economic competitiveness of the health and research sector by providing a frame for attracting research and development funds. In this way, CHRONEX-RD will develop new research jobs in the future and will attract highly skilled workforce, which in turn, will promote related services and private investments.
- Increased institutional competitiveness by acquiring and implementing a quality management system for chronic care, which will become a powerful hub for both upstream and downstream economic activities (recruit and maintain researchers, absorption of research funding, pharmaceutical industry, private medical services, etc.). Furthermore, in addition to the direct impact on these three levels, this project will likely generate system-level information and awareness which will, in turn, engender changes in resource allocation paradigms by public authorities (financial policies adapted to the changes generated).
Knowledge-practice gap – There are numerous gaps in the region compared to Western Europe as it pertains to specialized care in this complex field. Low funding levels (both public and private) for research, development and innovation in the field of CDs have direct negative impact on the existing research and development infrastructure in Romania, Ukraine and Moldova. The region still lags behind in technology and science capabilities while research workforce is scarce and older. This leads to lower performance of the research and development activities. Moreover, scarce research funding hindered the access of pharma business to the region’s research and development market and technology transfer opportunities for new technological developments.
Despite available expertise, research activities in the field lack synergy and coordination. There is no regulatory system in place to deal with procedures, standards and good practices in the field in any of the three countries involved. Research is dissipated across small institutions yielding only local-impact or redundant results while knowledge transfer and translation to clinical practice is inefficient due to the lack of connection with the research institutions. Therefore, medical practice is not adapted to the challenges and current knowledge in the field of CDs, thus creating a major knowledge-practice gap. This project aims to bridge knowledge-practice gap by implementing a model of community research.