![]() ![]() By the 1700s, however, industrialization, modernization, new medical technologies, and public health measures were transforming the lives of people living in many Western countries. Access to doctors was limited, as were effective medical therapies, so families usually took care of their own sick members however, the duration of that care tended to be relatively short. Prior to the 1900s, acute health conditions rarely could be treated successfully by medical therapies, so they were self-limiting, as they led to either spontaneous recovery or to death within a fairly short period of time. Notable among acute, communicable diseases was the bubonic plague, which caused more than 20 million deaths in Europe between 13 (Cockerham 2001). ![]() Whether endemic or epidemic, these illnesses contributed heavily to the high mortality rates and short life spans among persons living in pre-industrial societies. In most cases, acute illnesses occur suddenly and are characterized by a sharp increase in discomfort and pain due to an inflammation, and are of short duration. These conditions gave rise to acute illnesses such as influenza, scarlet fever, whooping cough, polio, pneumonia, and tuberculosis. ![]() Sickness and death historically were caused mostly by poor nutrition, inadequate housing, unsanitary living conditions, poverty, warfare and-as population density and urbanization grew-exposure to bacteria, parasites, and communicable diseases. Finally, the rise of chronic illness has increased the role of families in providing care for their sick and/or disabled members and caused governments to reassess their health policies. Second, chronic illness challenges the assumptions of modern medicine which, based on the "germ theory" of disease, has focused on finding cures for short-term illnesses with clear causes. First, it accentuates global disparities in health and wellbeing, as most people living in less-developed countries have shorter life spans and high rates of death from acute, parasitic, infectious, and/or poverty-related illnesses. This shift in the disease burden from acute to chronic illness has several important consequences. In many cases, the specific cause of a chronic illness cannot be determined, and its diagnosis and treatment can be difficult. Chronic illnesses, now the leading cause of death in industrialized countries, often develop gradually due to a combination of environmental, genetic, or social factors. As these examples suggest, chronic illnesses range in severity from those that are relatively mild and can be controlled by medical therapies and changes in health behaviors to those that are severe, degenerative, and terminal, causing disability and creating the need for long-term, extensive medical care. Examples of chronic illness include asthma, allergies, heart disease, diabetes, hypertension, stroke, cancer, cystic fibrosis, sickle-cell disease, varicose veins, arthritis, cirrhosis of the liver, renal disease, and mental illness. The National Commission on Chronic Illness defines a chronic illness as having one or more of the following characteristics: It is long-term or permanent it leaves a residual disability its causes, natural course, and treatment are ambiguous it is degenerative it requires special training of the patient for rehabilitation and it requires a long period of supervision. By the mid-1900s, people living in developed (industrialized) countries experienced a sharp decline in their incidence of acute, infectious illness and an increase in rates of chronic illness. Patterns of health, sickness, and death differ dramatically among countries based on levels of economic development, health policies, and medical technologies. ![]()
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