This week’s issue of The Economist† features an article discussing the findings from a series of reports from the human medical journal Lancet, which describes the dramatic change in the types of diseases that now confront the world population.
The reduction of infectious diseases has increased worldwide longevity and medical professionals must now concentrate on the management of chronic diseases commonly associated with longer lifespans and poor lifestyle choices. The comparison of various medical and hospital statistics spanning three decades led to the development of a tally of disability-adjusted life years, or DALYS. These numbers represent a measure of years lost to ill-health, disability, and early death. I was struck at the similar changes that are occurring in companion animals and how their DALYS will dramatically change how we practice veterinary medicine and the impact those changes will have on pet owners.
The Lancet Report on Human Longevity
The study was coordinated by Dr. Christopher Murray of the University of Washington. He and his colleagues examined death certificates, hospital and police records, and census information from almost every world country to compare life expectancy against 291 diseases and injuries. What they found was that deaths from infectious or transmissible diseases have decreased significantly due to public health and vaccination programs, antibiotics and insecticides. Worldwide efforts to alleviate malnutrition have positively impacted longevity, especially in combating conditions that affected women and children. In the 30 year research period some countries had experienced gains of 20 years life expectancy.
But researchers also found that 42 weeks of healthy life for each year increase in life expectancy was accompanied by 10 weeks of illness. Diseases like heart disease, diabetes, cancer, strokes, and back pain had increased during the study period. From 1990-2010 predisposing factors for disease and death - like high blood pressure, alcohol and tobacco consumption, inactivity, and poor diet - had replaced previous factors that were a function of poor nutrition and living conditions. Worldwide medical programs must now shift from an emphasis on vaccines and antibiotics to strategies that address management of these chronic conditions, and social and legislative programs that target lifestyle.
The Similarity of Pet Health to Human Health
Multiple studies in animals have confirmed the same trend of increased longevity. Like the above report, low cost, readily available vaccines, flea and parasite products, and consistent nutritional standards for commercial pet food have decreased infectious and transmissible diseases and maladies related to malnutrition. Like humans, an estimated 50% of pets are overweight or obese, so we are seeing the same shift in pet problems. Diabetes, kidney dysfunction, cancer, osteoarthritis, cardiovascular disease, and chronic pancreatic and intestinal conditions are eclipsing distemper, parvovirus, panleukopenia, feline leukemia, heartworm, etc. Like humans, pets will have more ill days or DALYS, and veterinary practice will change from immediate care of acute problems to the prevention and management of chronic disease.
I now dispense far more medications for pain management, inflammatory control, blood pressure control, and hormonal supplementation or suppression, than the antibiotics that characterized my first years of a 30 year career. Specialized diets for management of chronic diseases is much more common now as infectious diseases seldom need such intervention.
I envision that most veterinary hospitals will provide physical therapy facilities. Weight management and nutritional counseling will become more dominant than vaccines and parasite control in wellness programs. More periodic disease monitoring (blood tests, blood pressure, etc., administering alternative treatment protocols (laser therapy, massage and range of motion therapy, water therapy, etc.) and dietary education will become more common tasks for technical staff than treating acute patients on fluids. Chemotherapy and cancer treatment will become more common for general veterinary practitioners.
DALYS Impact on Pet Owners
The treatment of chronic disease will substantially increase veterinary care costs for owners. More frequent and costly therapies over longer time periods will be more common than visiting the vet only periodically for more minor, acute aliments. Unlike vaccines and spay and neuter services and discount food sources, low cost alternatives for the treatment and management of chronic disease will be less available. Although prevention programs can decrease these future costs, compliance may still require more frequent veterinary visits than owners are presently accustomed. Increased costs may dramatically change the demographics of pet ownership.
Chronic disease also requires more constant, committed, and sometimes intense involvement on the part of the owner. Such an adjustment may be difficult for some individuals or families.
Due to these impacts, rescue organizations and pound facilities may find themselves overwhelmed with an older population of animals with fewer prospects for adoption and care.
Hopefully, changes in pet insurance policies, technology advancements lowering equipment and monitoring costs, prevention programs, nutritional advances and successful lifestyle intervention can attenuate the effect of DALYS in the lives of pets, owners and veterinarians.
Dr. Ken Tudor