Demographic aging of the population, which is a consequence of improving the quality of life, the development of medicine has posed a global problem to society: an increase in the number of chronic diseases. If earlier in the top ten of its causes included diseases such as tuberculosis, pneumonia, diarrhea, now these are cardiovascular diseases (CVD), oncological diseases, lung diseases, diabetes mellitus (DM) and others. On the one hand, this indicates progress in the diagnosis and treatment of diseases caused by infectious agents, the creation of new drugs. On the other hand, this indicates that other factors determining mortality have come out on top and these include not only age, but also dietary changes, smoking, stress, obesity.
The catastrophic increase in the number of patients observed in recent decades has set the medical community the task of improving the quality of life of this category of patients. To do this, it was necessary to solve not only medical, but also social aspects of comorbidity. The lack of standardized criteria for diagnosis, prognosis, treatment, large economic expenditures on patient care indicates the urgency of the problem; it has not only medical, but also social significance. Therefore, a multi-level approach to chronic diseases is necessary, with the inclusion of society and health authorities, which will also ensure the prevention of diseases. In connection with the above factors, the need to study chronic diseases from the point of view of public health and the relationship of their prevention with the influence of other disciplines is determined.
Relations to Public Health Via Health Science
Health systems that adhere to current methods of disease control cannot afford to continue to take care of the escalating number of people with chronic diseases. At the moment, 50-80% of all global health spending is associated with chronic diseases (Nyberg et al., 2020). Therefore, health sciences are aimed at organizing the management of chronic diseases. Based on scientific research, a systematic approach is being implemented to coordinate health interventions at different levels: individual, organizational, local and national (Nyberg et al., 2020). Such coordination between care services and public health organizations is more effective than single or uncoordinated interventions.
Management of chronic illness in the field of public health is a holistic concept based on health sciences, which organizes the structure and procedure of medical care adequately to the process of disease development in a particular patient. Worldwide, it is considered best practice to provide medical care by a coordinated group of health professionals (Anderson & Durstine, 2019). Patients receive services from more professionals, ideas from different bodies of knowledge and a wider range of skills. Thus, reliance on the scientific validity of treatment is perceived as a criterion of high quality of medical care.
The provision of medical care to people with chronic diseases should be guided both by considerations of the economic efficiency of public health and by consideration of the disease according to the theses of the health sciences. It is extremely important to develop an effective healthcare strategy for this group of patients. Only taking into account both factors will be able to provide them with smooth, professional and effective treatment in the healthcare system. Comprehensive medical care can be provided only if the main theses of the health sciences are regularly integrated into the public health system.
Influences of Interdisciplinary Collaborations on Health Outcomes
Currently, there is an obvious need for scientific understanding of the interdisciplinary medical and sociological context of the phenomenon of chronic diseases. Consideration of these diseases in the framework of an interprofessional and interdisciplinary approach will avoid dysfunctional practices of the social institute of health. Today, there is a deterioration in the state of public health around the world, an increase in the incidence and disability of the population with chronic diseases in all age groups (Anderson & Durstine, 2019). Therefore, there is an urgent need to design new interdisciplinary approaches in the formation of strategies for helping patients with chronic diseases.
The use of integrated treatment programs for some common chronic diseases also reduces costs and increases the effectiveness of treatment. An integrated approach to the treatment of a patient with a certain disease is understood as a specific way to solve a certain clinical problem. It is based on the use of a detailed structured plan and a multidisciplinary principle, implying close interaction and continuity in the work of doctors of various specialties in the management of patients.
This approach was proposed in order to ensure more effective implementation of national recommendations for the treatment of certain diseases in practical healthcare. For example, in several randomized clinical trials, it has been proven that the use of a multidisciplinary approach to treatment can improve the effectiveness of treatment of patients with chronic diseases (Nyberg et al., 2020). This approach involved the collaboration of several specialists in the treatment: cardiologists, lipidologists, clinical pharmacologists, nutritionists, specially trained nurses and other medical staff worked closely together. Thus, the distribution of responsibilities between the participants of the program and the continuity of work between them is extremely beneficial (Nyberg et al., 2020). This interdisciplinary collaboration allows for more successful early diagnosis of the disease, optimal treatment and dynamic follow-up of patients with chronic diseases.
Collaboration Across Disciplines for Disease Prevention
The main disadvantages of the system of prevention of chronic diseases are primarily associated with weak interdisciplinary collaboration, which justifies a set of measures to optimize it. Separate areas of scientific research in various fields of nutrition are closely related to each other. These approaches, confirmed by practice, as well as a number of modern scientific studies, can be more widely used to prevent the occurrence of chronic diseases.
The reasons leading to the increased prevalence of chronic diseases among the population are quite multifaceted. These are high blood pressure, smoking, alcohol, high cholesterol in the blood, overweight, sedentary lifestyle and others. For many people, especially those belonging to socially disadvantaged groups, risk factors often combine and mutually reinforce each other. Thus, among smokers, mortality from cardiovascular diseases is 2 times higher than among non-smokers (Cardoso et al., 2018). The ongoing comprehensive work on the prevention of chronic diseases leads to a decrease in morbidity, or increases the likelihood of early diagnosis and withdrawal of the patient into remission.
Preventive measures carried out comprehensively against cardiovascular and oncological diseases, mental health problems, diabetes mellitus also lead to the prevention of the appearance of chronic diseases of the musculoskeletal and respiratory systems. Thus, there is no doubt that, due to the similarity and interrelation of the causes of chronic diseases, the prevention of each of them has a positive effect on related areas of health care.
Prevention and Health Promotion Strategies
At the moment, national preventive measures are being actively developed as part of strategies for the prevention of chronic diseases and the promotion of health. Thus, these strategies involve the implementation of prevention programs, both at the population level and in high-risk groups of chronic diseases. In order to solve the main problem of the high-risk strategy associated with a small but widespread risk, the criteria of high-risk groups are constantly being expanded in the updated clinical guidelines for the prevention and treatment of various chronic diseases.
Examples of prevention programs are the ban on smoking in public places, the restriction of sales of tobacco products and alcoholic beverages by age and time. Examples of the implementation of programs to promote a healthy lifestyle are the opening of centers for medical prevention and health (Raghupathi & Raghupathi, 2018). They teach hygiene skills and motivate citizens to give up bad habits, including assistance in giving up alcohol and tobacco consumption, as well as work with the family.
Taking into account the current situation, it is necessary to use multi-level prevention programs based on evidence. The measures taken today range from simple and easily implemented to more comprehensive, interdisciplinary and future-oriented (Conversano, 2019). Thus, being multidirectional, prevention strategies do not contradict each other, and their joint application is not just possible, but also desirable. To successfully combat chronic diseases, it is necessary to maintain a balance between two strategies for prevention and promotion of a healthy lifestyle.
In order to achieve the strategic goal, set to further prevent the growth of chronic diseases, it is necessary to bridge the gap between different medical areas. The tasks of organizing the switching of medical care to the population at the present stage of health care development are to use the available health resources efficiently and economically. In addition, the commutation needs are to increase the availability and improve the quality of medical care.
The improvement of the organization of medical care at the prehospital and hospital stages in recent years has led to significant changes in the structure of outpatient and inpatient stages of providing medical care to the population. Currently, the development of healthcare is characterized by the widespread use of economic management methods (Anderson & Durstine, 2019). The improvement of commutation is also facilitated by an in-depth analysis of the state of inpatient and outpatient polyclinic care to the population and their reform taking into account prospective needs, the introduction into practice of progressive forms of treatment and prevention of chronic diseases.
The success of the reforms depends not only on the optimization of the activities of medical and preventive organizations. An important need for commutation is also to ensure continuity between individual elements of different health sectors. The system of medical care for the population consists in the organization of interrelated sequential measures (Anderson & Durstine, 2019). It is this organization of commutation that makes it possible to ensure continuity and an integrated approach to the diagnosis and treatment of chronic diseases. These measures are implemented in medical and preventive institutions of various levels, each of which has its own s commutation needs (Nusinovici et al., 2020). As a rule, they depend on the stages of medical care provided, as well as on the capacity, equipment, specialization of departments and services, qualifications and training of personnel.
Sociocultural diversity plays a great role in the prevention and detection of chronic diseases, since the level of risk for the patient depends on this parameter. Risk factors for chronic diseases include potentially health-threatening phenomena, often defined or closely interrelated with the socio-cultural environment. First of all, these are environmental and social factors, industrial environment, habitat factors. In addition, biological and genetic cultural features increase the likelihood of developing chronic diseases, their progression and unfavorable outcome.
Biological risk factors include genetic and ontogenetic features of the human body. It is known that some diseases are more common in certain national and ethnic groups. There is a hereditary predisposition to the disease of hypertension, peptic ulcer disease, diabetes mellitus and other diseases (Raghupathi & Raghupathi, 2018). Obesity is a serious risk factor for the occurrence and course of many diseases, including diabetes mellitus, coronary heart disease (Shahidi & Yeo, 2018). The existence of foci of chronic infection in the body (for example, chronic tonsillitis) can contribute to the disease of rheumatism (Wang et al., 2017). Environmental risk factors depend on the social environment, as people of a lower stratum are more likely to be exposed to changes in the physical and chemical properties of the atmosphere, which affect, for example, the development of bronchopulmonary diseases (Leuti et al., 2020). Sharp daily fluctuations in temperature, atmospheric pressure, and magnetic field intensity worsen the course of cardiovascular diseases (Wang et al., 2017). Social risk factors also include unfavorable housing conditions, various stressful situations. In a higher social stratum, the risk factor is the peculiarities of a sedentary lifestyle, leading to the development of many chronic diseases, especially diseases of the cardiovascular system (Anderson & Durstine, 2019). Harmful habits, such as smoking, which are a risk factor for chronic bronchopulmonary and cardiovascular diseases, are more common among representatives of a lower social stratum (Wang et al., 2017). Also, the social factor plays a role in the degree of alcohol consumption, which is one of the causes of the development of chronic liver and heart diseases.
Impact on Sociocultural Diversity
Mindfulness, respect, and flexibility for sociocultural diversity impact the healthcare environment. First of all, this approach allows to pay due attention to all risk factors. There is no doubt about the significant role played by socio-cultural factors in ensuring human health, since they are directly related to heredity (Leuti et al., 2020). In the vast majority of cases, knowledge of these factors and correction of human behavior or its adaptation can help prevent the occurrence of chronic diseases.
It is also necessary to be flexible in working with patients belonging to a low social stratum, who are strongly influenced by the external environment. This may be due not so much to the geographical and climatic conditions of the region, as to the industries in which the patient works. For example, the incidence of chronic respiratory diseases and allergies is much higher among those employed in metallurgy centers (Shahidi & Yeo, 2018). The harmful effects of tobacco smoke during passive smoking also refers to the factors of the social environment that affect human health (Cardoso et al., 2018). The incidence of bronchial asthma and bronchitis is increasing among representatives of a higher social stratum, most often living in large industrial centers (Anderson & Durstine, 2019). Thus, when implementing measures for the prevention or treatment of chronic diseases, socio-cultural characteristics should be taken into account; such flexibility for socio-cultural diversity will help improve the healthcare environment.
There are chronic diseases that occur only among representatives of certain peoples. They are embedded in the gene pool of the nation and characterized by a clear ethnic attachment, regardless of where the patient lives at the time of the onset of the disease. There are also endemic chronic diseases; they occur in a certain area, regardless of the nationality of the inhabitants. In this paper, chronic diseases of both types are considered, and thus socio-cultural characteristics are taken into account.
An example of an ethnic, genetically determined chronic disease is a chronic illness, also called Mediterranean fever. Representatives of nationalities and ethnic groups whose ancestors lived in the Mediterranean basin are mostly ill. The cause of the disease is an abnormal protein – amyloid, which is deposited in the internal organs, affecting them (Merlo, 2019). The protein is produced by a mutant gene; it is transmitted to the patient from the parents, and the latter may be healthy externally. Sensitivity to alcohol in individuals and entire nations is also associated with genetic features. The rate of development of chronic heart and liver diseases depends on the number of enzymes – alcohol dehydrogenases and aldehyde dehydrogenases that break down alcohol in the blood (Cardoso et al., 2018). The peoples of the Far North, migrants with Asian roots have a lower level of these enzymes compared to other peoples.
The course of such a chronic disease as hypertrophic cardiomyopathy is influenced by race. At the same time, renovascular hypertension in blacks is much less common than in whites (Shahidi & Yeo, 2018). Consequently, it depends on the ethnicity of the patient which measures of the diagnosis of chronic diseases should be given special attention.
Impact of Ethical Values and Practices
Attention to the cultural contexts of health, illness and treatment plays an important role in the prevention and resolution of problems associated with chronic diseases. The experience of the development of medicine shows that since the 1950s, many doctors and heads of health services in developed countries have regularly attempted to enlist the support of experts in the field of social and humanitarian knowledge (Nyberg et al., 2020). In the treatment of chronic diseases, one should also take into account the values, beliefs, ideas, and in addition, the social institutions and networks of the patient’s nationality.
In all societies, regardless of their level of development, health problems are always in the spotlight. However, in some cultures, the complex of ideas and practices associated with them is a more stable element than the health culture. For example, migrants from African countries or Latin American countries require special attention in connection with the development of unconventional medicine: herbalism, spiritual healing, magico-religious healing (Cardoso et al., 2018). Despite the supply of medicines, the implementation of sanitary-medical programs and the introduction of hygiene standards, sanitary-medical measures in African-American and Latin American neighborhoods can be implemented inefficiently (Cardoso et al., 2018). Therefore, it is necessary to apply knowledge about cultures and cultural differences, solve acute issues of medical practice, and propose new approaches to protecting the health of societies alien to the Western cultural tradition. The most important in this case are ways to overcome cultural barriers, as well as information concerning local hygienic customs and ideas about the body, health and disease.
The medicine of chronic diseases is considered not only as a system of medical institutions where doctors and patients interact, but also as a system of special communities with a specific culture, rituals, and their own forms of communication. Currently, a doctor working with patients with chronic diseases needs to have certain knowledge in the field of social anthropology. First of all, it is the study of the field of ethnomedicine, which deals with the analysis of health systems in different cultures.
Considering these aspects, it is possible to consider the issues of prevention of chronic diseases from the perspective of the socio-cultural background of the patient. Local value ideas about life and death, health and illness, pain and suffering have quite deep socio-cultural roots, firmly entrenched in the public consciousness of peoples and changing very painfully. In this regard, sometimes there are difficulties in medical activity, so it is necessary to integrate the value concept of the patient into the medical space. The analysis of the problem shows that many communities may be influenced by non-traditional or alternative medicine (Cardoso et al., 2018). They are far from scientific, but they are strong because of religious feelings rooted in the public consciousness, faith in healers, sorcerers and psychics.
Thus, reflection on the problems of social diversity of patients with chronic diseases emphasizes the need for doctors to recognize the determination of a healthy lifestyle, health and illness, life and death by socio-cultural and ethno-cultural causes and conditions. Ethnico-cultural understanding of the problem leads to an understanding of the multidimensional nature of the medical process, in particular its ethical, the study of which is possible on the basis of a comprehensive interdisciplinary approach to the study of man and the peculiarities of his existence.
Communities of any cultural or ethnic background with a high percentage of chronic non-communicable diseases are relevant for this work. Slowly progressing health pathologies are common in all age groups and all regions. However, certain diseases are more common in certain communities. For example, for the study of cystic fibrosis, a community of white people is suitable, since they often have a mutation of the gene that regulates salt metabolism (Leuti et al., 2020). Chronic celiac disease, in which the body is unable to digest cereals, is likely to be most often manifested in representatives of the Irish community (Shahidi & Yeo, 2018). In the study of such a chronic disease as diabetes mellitus, it is necessary to monitor migrants with North Asian roots (Leuti et al., 2020).
In the study of chronic cardiovascular diseases, it is worth contacting both the community of white people and the community of African Americans. Genes play an important role in the intensity of their development: for example, the apolipoprotein gene is involved in the regulation of cholesterol levels (Leuti et al., 2020). It exists in different versions: one effectively extracts cholesterol from food and accumulates it in the body, the other option gives a low cholesterol level. Hunter-gatherers (peoples living mainly in the tropical zone) had a traditional low-cholesterol diet. Members of the African-American community, in whom the first variant of the genes are more common, are more susceptible to hypertension than Euro-Americans.
Reaching Target Audience
The target audience of this paper is both doctors and nurses working with patients with chronic diseases, and the patients themselves. It will be most useful for patients at risk, as well as for doctors working with ethnic communities. The problem of chronic diseases does not affect only one specific state or city, so there is no need to determine the target audience by demographic (Shahidi & Yeo, 2018). To reach target audience, the work should be published on the Internet as in specialized medical journals or blogs. In addition, it can be also published on health websites for users who are not related to medical topics. Since chronic diseases do not depend on gender, the target audience will be both men and women of different ages. It is more logical to segment patients by nosology, surgeries and medical characteristics inherent in certain chronic diseases (Nyberg et al., 2020). In order to reach a part of the audience suffering from chronic diseases, it is possible to publish this work on forums of people with certain diseases.
Benefits of the Appropriate Communication Skills
Effective communication is at the heart of all nursing and medical actions in the process of caring for chronic patients. It is an integral part of the treatment process and an important condition for the effective implementation of all its stages: research, diagnosis, planning, implementation and evaluation. In this regard, the study of the importance of effective communication and awareness of its importance is of great practical importance.
The treatment process is not a unilateral act of nurses and doctors, it is a process of interaction with other team members, but mainly with the patient and his relatives. This is the process of jointly setting goals, an action plan, expected results and evaluating the results achieved. In this process, a patient with chronic diseases becomes an active subject of the long-term care process. Doctors working with chronic patients unanimously confirm that effective communication is an essential tool for improving the quality of long-term care (Cardoso et al., 2018). The result of the treatment process is largely determined by fruitful communication between the nurse, the patient and his relatives. In this regard, communication skills are necessary to attract the patient and his relatives as active participants in the long-term care process.
Mastery Of Information Literacy in the Health Sciences Field
In the process of examination and observation, the attention of scientists is attracted to the study of unresolved issues regarding various clinical features of the combined pathology of chronic diseases. Also, the spread of the use of scientific research as a support is evidenced by the use of data from numerous studies confirming the existence of a link between various chronic diseases.
The study of the quality of life in clinical medicine is a unique approach that has largely changed the traditional view of the problem of illness and the condition of a chronic patient. The examination standards, based on a wide range of laboratory and instrumental indicators, reflected only the biological component of the disease (Nyberg et al., 2020). They did not give a complete picture of the condition of a patient with a chronic disease, his attitude to his disease, the degree of his maladaptation.
The quality assessment based on the subjective opinion of the patient, given according to the existing scientific literature, can significantly complement the clinical picture, provide an individual approach to the patient, monitoring of treatment. The determination of the features of this indicator by a doctor in certain nosological forms, the influence of the severity and duration of the disease on the quality of life is an indicator of information literature in the health sciences field.
The result of most interventions largely depends on organizational factors, such as increasing the literary and anthropological literacy of the doctor. In addition, an interdisciplinary approach should be formed, requiring the collaboration of various medical sciences. Also, the guarantee of successful prevention is the formation of a treatment complex taking into account the priorities and needs of the patient and his family. A medical officer is the most important segment in the process of providing medical care, and his qualifications can directly affect the availability, safety and effectiveness of the care provided. Therefore, doctors and nurses need to have an understanding of the cultural and social characteristics of different populations in order to apply the most appropriate approach to treatment and identify risk factors.
If working with migrants with African, Asian, Latin American roots, doctors should be aware of their cultures, worldviews, religions, spiritual practices. In the field of healthcare, such specialists are needed; they are needed primarily where the population is multicultural, multinational, multi-confessional. In the USA, a country with a complex population, medical specialists in chronic diseases have additional knowledge in the field of medical anthropology and bioethics, are in great demand. The use of socio-cultural practice will allow solving the most important world problems in the field of health preservation: the prevention of chronic diseases.
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