Rethinking Strategies for Addressing Chronic Ailments with Insights from Ernesto Moralez

As chronic diseases like heart disease, cancer, and diabetes have risen to prominence as the main culprits behind mortality in developed nations, they have established a commanding presence. Chronic physical ailments lack the element of contagion possessed by infectious diseases such as tuberculosis or pneumonia. With the attention shifting to these conditions, there has been a noticeable focus on proactive steps for prevention, especially in regard to dietary changes and increased physical exercise. However, one must also admit that these diseases hide subtle precipitators that often go unnoticed by general observation. In the subsequent discussion, we will focus on the driving forces of chronic diseases and how looking at these factors more holistically can enhance effective approaches toward preventing and managing them.

The 20th century was marked by a radical shift in the associated causes of deaths occurring in developed countries. It used to be infectious diseases that prevailed on the scene and caused high mortality, but today, infectious diseases have paled in comparison to chronic diseases. Health concerns these days need outward care towards these persistent conditions and not towards the fleeting infectious diseases, as heart disease, cancer, and diabetes are now occupying a central place of health concerns. Remarkably, all these chronic disorders have highly complex and idiosyncratic etiologies, but without any infectious agents and the typical transmissibility.

In response to the growing incidences of chronic diseases, both the medical as well as public health domains have seen a paradigm shift in their fundamental mandates. Preventive measures have assumed center stage, emphasizing lifestyle modifications such as refining dietary habits and amplifying physical activity. Additionally, pharmaceutical treatments have increased in importance for managing these conditions. Although these efforts most certainly have constructive effects by the extension of longevity and improved quality of life, they often overlook the agents underlying the prevalence of chronic diseases.

A leading public health educator, Ernesto Moralez argues for a departure from the idea of leading people into a moral responsibility to eat better and work out. According to Moralez, such interventions usually come towards the end of life and hardly influence the severity of chronic illnesses.

As a result, instead of this kind of approach, Ernesto Moralez proposes solutions for the root of chronic diseases through societal intervention, including social responsibility. He points out the need to consider the underlying causes of disease clusters for chronic diseases. County maps showing the number of diabetes cases, for instance, depict clusters in lower-income areas that have low access to health services, the highest unemployment rate, and the poorest conditions for neighborhoods.

As such, zoning and restricting the accessibility of tobacco and vaping products to minors in poorer neighborhoods is one example of a policy action that can work to influence the diffusion of chronic disease via the window of a policy-based intervention. Measurable differences in the recurrence of chronic diseases can be realized by public health officials through the implementation of this fresh perspective, but only after the policy changes have been enacted.

Indeed, Ernesto Moralez has put his ideas and research on the chronic disease management domain in a forthcoming edition of a public health textbook, Introduction to Public Health, which he co-edited with two other authors to come out in 2024.