TABLE OF CONTENTS
Th e global challenge against non-communicable diseases gained transnational attention over the last years. Statistics illustrate, that approximately 70% of all deaths worldwide can be traced back to chronic diseases (WHO, 2014). On the other hand, artificial intelligence is on the rise as the number of implemented software featuring machine-learning skills increased tremendously in the last years. Therefore, the purpose of this literature review is to combine those aspects in order to create synergies of the link between existing approaches with the aim to face non-communicable diseases and artificial intelligence. The review focusses firstly specifically only on the most prevalent NCDs and their characteristics before analysing the rise of machine-learning software from the very beginning. In a next step, those two fields will be combined with the aim to point out both benefits and risks when implementing AI in the healthcare sector. The outcome was, that the use of such software would definitely cut a three- digit number of billions of Euros of spending on healthcare due to the possibility to early-detect diseases and the hereby arising possibility to treat patients in a more efficient way as until now. On the other hand, the biggest risk will be, that artificial intelligence works on huge datasets that need to be set up first – during the setting up process of such data, failures can take place which would have a grave impact on further use.
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Non-communicable diseases (hereinafter referred to as NCDs) are omnipresent, 95% of the world’s population are suffering from at least one burden, every third person suffers from more than five physical deficiencies (Neue Züricher Zeitung, 2015). Chronic diseases cause nearly 40 million deaths per year, which is equivalent to 70% of all deaths globally. The four major and most prevalent NCDs are cardiovascular diseases, cancer, chronic respiratory diseases and diabetes – these physical deficiencies account for most NCD global deaths (WHO, 2014). In Europe, these four NCDs “account for nearly 86% of deaths and 77% of disease burden” (WHO Regional Office for Europe, N.D.) while the population in developing countries seems to be the most vulnerable group of people, as 85% of the ~14 Million deaths caused by NCDs between the ages 30 and 70 are noticed in developing countries (WHO, 2014). Behaviour factors such as tobacco use, excessive alcohol consumption, physical inactivity and unhealthy eating habits increase the risk of dying from NCDs significantly. Furthermore, rapid unplanned urbanization, globalization and population aging are forces, that are responsible for the rising prevalence of chronic diseases over the past years (WHO, 2017).
To break these numbers down into the population of Tyrol, the health report published in 2013 by the Tyrolean provincial government was analysed. According to the Tiroler Gesundheitsbericht 2012 (Amt der Tiroler Landesregierung, 2013), from 2006 – 2011 an annual death rate of slightly more than 2.700 women was observed. From these 2.740 annual deaths:
- 1.250 were caused by cardiovascular diseases
- 660 were caused by cancer
- 150 were caused by chronic respiratory diseases
From 2006 – 2011 an annual average death rate of 2.510 men was noticed. From these 2.510 annual deaths:
- 870 were caused by cardiovascular diseases
- 760 were caused by cancer
- 190 were caused by chronic respiratory diseases
An analysis of the disease pattern in Tyrol showed, that cardiovascular diseases, cancer and chronic respiratory diseases are the main causes of deaths in that region.
Nevertheless, NCDs do not only affect the health condition and therefore the living standard of people – the WHO Regional Office for Europe (WHO Regional Office for Europe, N.D.) stated in a factsheet, that socioeconomic consequences such as poverty are closely linked with chronic diseases as the healthcare costs for them can quickly drain the household resources of patients. Moreover, vulnerable and socially disadvantaged people get sicker and die sooner due to a greater risk of being exposed to harmful products such as tobacco or alcohol and limited access to health services. Furthermore, a connection between NCDs and economic productivity can be noticed. When taking a closer look at this connection it has been estimated, that “f or every 10% increase in NCD mortality, economic growth is reduced by 0 . 5 %” (WHO Regional Office for Europe, N.D.). Besides that, the disability, which emerges from being affected by a chronic disease “can lead to a decrease in working-age population participation in the labour force and reduce productivity and, in turn, reduce per capita gross domestic product growth” (Engelgau, Rosenhouse, et al., 2011)
All this information leads up to the question on how we can use modern resources like artificial intelligence in a variety of processes within the healthcare sector in order to firstly decrease the possibility to suffer from one of the abovementioned diseases and secondly to treat patients in the most efficient way possible. To analyse the status quo this literature review is structured as follows: first of all, a rough overview of the term “non-communicable diseases” will be given whilst explaining the clinical picture of the most prevalent ones. Afterwards, two common approaches on how to face chronic diseases will be discussed before leading over to the term “artificial intelligence”. In the first place, this term will be defined, followed up by the historical development of this specific field in order to gather a broader understanding about its functioning. Lastly, the link between artificial intelligence and the healthcare sector will be outlined – benefits and risks of an implementation will be discussed in order to provide the reader with some objective information.
2. NON-COMMUNICABLE DISEASES
In the following chapters the term non-communicable diseases (NCDs) and its different characteristics will be explained. Burdens which are caused by chronic diseases will be outlined and challenges that occur when facing NCDs will be analysed.
After a brief definition by the WHO, the focus will then be drawn especially on cardiovascular diseases, cancer and diabetes, as those burdens are the most prevalent ones worldwide but also in Tyrol. Additionally, most people who die from NCDs die from those diseases, therefore the necessity to take a closer look at this problem is definitively given.
Furthermore, the difference between health promotion programs and prevention programs will be outlined – the focus will be drawn especially to primary, secondary and tertiary prevention but also to different prevention approaches.
2.1 GENERAL INFORMATION ABOUT THE MOST PREVALENT NCDs
The characteristics of NCDs are, that they are “a result of a combination of genetic, physiological, environmental and behaviours factors” (WHO, 2017) – furthermore, they tend to be of long duration and slow progression.
The main NCDs, the ones whose prevalence and death rate is the highest, are cardiovascular diseases, different variations of cancer and diabetes. In the following section, CVDs, cancer and diabetes will be explained briefly in order to get a rough overview on what those diseases are about.
The term “cardiovascular diseases” is used as an umbrella phrase for a variety of diseases of both the heart and blood vessels. The main trigger for CVDs is arteriosclerosis, which describes the ageing process of the blood vessels and therefore their loss of elasticity or their narrowing. Usually, the symptoms of arteriosclerosis remain undiscovered until the vessel diameter is reduced significantly. Nevertheless, the progress of arteriosclerosis is determined by several physical, environmental, social and behaviours factors. (Griebler, Anzenberger & Eisenmann, 2014)
Cancer is a disease, that can arise in many different variations: lung cancer, breast cancer, bowel cancer – just to name a few. Also, cancer is not one single disease, “it is actually a group of more than a hundred diseases that have one basic thing in common: A change occurs in the body that causes cells to grow and multiply uncontrollably” (Silverstein, A., Silverstein, L., & Silverstein, V., 2006).
The World Cancer Report (International Agency for Research on Cancer, 2014), which was published in 2014 by the International Agency for Research on Cancer, a department administered by the WHO, gave detailed information on both the current situation with cancer and future perspectives but also focused on prevention programmes. According to the report, in 2012 approximately 14 million new cases of cancer and about 8 million cancer-related deaths were observed. The most prevalent sites of cancer can be found in Figure 1.
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(based on: International Agency for Research on Cancer, 2014)
Diabetes mellitus– commonly used as Diabetes – is basically a metabolic disorder, which leads to a high blood sugar level. The level can increase until the sugar gets exuded with urine, because the kidneys cannot hold back the too high amount of sugar. In Europe, approximately
53 million inhabitants are affected either by Type 1 Diabetes Mellitus or Type 2 Diabetes
Mellitus (ÖDG, N.D.).
In Austria, it is estimated that about 600.000 people are suffering from Diabetes while approximately 20% of the affected persons are unaware of their disease. Diabetes Mellitus can lead to serious second diseases like heart attack, stroke, amputations, etc. which is the reason, why corrective measures have to be implemented in order to decrease the prevalence of Diabetes. Risk factors are similar to the ones of the other non-communicable diseases – people who are less educated, have less income or do have a migration background are more often affected by obesity and are therefore at higher risk to develop Diabetes. (BMGF, 2017)
2.2 HEALTH PROMOTION AND PREVENTION PROGRAMS
Health promotion and prevention are two processes, that might seem similar to each other but differ slightly in both their execution and definition. First of all, an understanding of the definition of “health” is needed. The WHO described health in their constitution as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” (WHO, 2018). Therefore, being healthy signifies more than just feeling physically well.
But what can we do to achieve and maintain a healthy life? Health promotion is based on the knowledge about which factors increase the chance for a healthy life (the chance for an increased amount of healthy life years) and aims at promoting these factors (Fonds Gesundes Österreich, N.D.). Health promotion programs are therefore unspecific measures that aim at an increased population health – e.g. a hiking day within the company, physical exercise at work, etc.
Prevention, on the opposite, is based on the knowledge about what weakens and harms the health state and strives after reducing those factors (Fond Gesundes Österreich, N.D.). In detail, prevention programs are specific measures to increase the population health. Prevention programs can furthermore be divided into three parts, which differ from each other in their definition:
Primary Prevention = activities to reduce the incidence of the disease and the individual risk of the disease before damage is observable.
Secondary Prevention = activities to early detect a disease in order to reduce the morbidity and to increase the chance of survival at the same time (e.g. screening).
Tertiary Prevention = activities to reduce social and medical consequences of an established disease (e.g. rehabilitation).
Besides the different segmentations of prevention measures there are also different prevention strategies, from which I want to outline two.
2.2.1 The High-Risk Approach
The high-risk approach (see: Figure 2) describes clinical, individual prevention. Its practices are counselling to change the individual risk behaviour, medication to delay the occurrence of the disease and screening to early detect an asymptomatic disease. Examples for a high-risk approach are: breast cancer screening, blood pressure checks, safe sex counselling, etc. Basically, the high-risk strategy can also be compared to a “face to face intervention”, as it controls the individual behaviour.
The positive aspects about this strategy are, that the intervention is appropriate for an individual at risk and that there is a favourable benefit-risk ratio. Furthermore, the motivation for an intervention like this is high for both, the physician and the subject (= individual).
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Negatives, that should be outlined are, that the costs for high-risk interventions are extremely high most of the time (e.g. screening). Secondly, the potential for the whole population is limited.
2.2.2 The Population Approach
The population approach (see: Figure 3) is, as the name already says, a population based intervention. It aims at modifying community determinants. Examples are: water supply protection, a smoke free environment or nutritional programs to name a few. The population strategy is also known as the “mass approach” as its target is to control the determinants of risk factors for the whole population.
The positive aspect about this strategy is, that the impact for the population as a whole is high even though there is only a small benefit for the participating individuals as such. This situation leads up to the so called “prevention paradox” which describes the fact, that a preventive measure brings much benefit to the population but offers little to each individual.
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On the other hand, the benefit-risk ratio of these interventions is worrisome. Even though the costs depend on the specific measure, the motivation for both the physician and the individual is rather low.
There are several examples, how health promotion and prevention programs can be implemented – one specific, also concerning the technical advantages nowadays, will be explained now.
“Sidekickhealth” is an evidence-based mobile platform to prevent and treat lifestyle related non-communicable diseases. The project is basically a social-health game and service for smartphones that allows people to improve their health and well-being by doing different activities in three categories. Those categories are: food (nutrition), mind (mental health) and exercise (physical health). “Sidekickhealth” can be used by providers or employers within a company and is “a unique combination of behavioural economics, the latest in gaming technology and artificial intelligence” (Sidekickhealth, 2018). This invention shows, that digitalization and the technical progress can be combined with interventions that aim at a better health state of a certain group of people. To some extent, this service even uses artificial
intelligence, even only at a very small scale, as everyone who uses this service, starts with different preconditions – but everyone will get the same “reward” after finishing a certain goal. Therefore, the app adapts very fast to the individual and supports him or her with a fitness or diet plan, fitting the respective needs and tracking their activities.
However, before trying to link artificial intelligence with its possibilities in the healthcare sector, the term itself has to be defined.
- Quote paper
- Julius Holaus (Author), 2019, Artificial intelligence in healthcare. An analysis of the link of AI to health promotion and prevention programs to face and early-detect non-communicable diseases, Munich, GRIN Verlag, https://www.grin.com/document/491644