Digestive diseases: Big burden, low funding? Results of the new United European Gastroenterology White Book on digestive diseases
Luigi Ricciardiello
Abstract
Digestive diseases affect over 300 million people across UEG member countries and are associated with substantial economic costs.1 The incidence and prevalence of many digestive diseases are highest amongst the very young and the elderly, and as the European population ages, the disease burden will inevitably increase. Unfortunately, despite their substantial prevalence and global impact, many digestive diseases are still poorly understood and attract relatively little attention from either a policy or funding perspective. We at UEG are committed to raising political and public awareness of digestive diseases throughout the continent, informing policy makers, and encouraging research. To support this effort, accurate and up-to-date information is needed on the true burden of digestive diseases and the current organisation and delivery of care. The Survey of Digestive Health Across Europe published by UEG in 2014 revealed changing trends in many high prevalence digestive diseases and worrying inequalities in the provision of healthcare services across the continent.2 To continue raising public and political awareness on digestive health and to support the implementation of ambitious prevention, screening and treatment strategies at the European and national level, UEG commissioned the White Book 2, entitled ‘Analysis of the Burden and Economic Impact of Digestive Diseases and Investigation of Research Gaps and Priorities in the Field of Digestive Health’. This analysis was conducted by a team of researchers from the University of Liverpool, specialised in epidemiology, health economics and public health, and was led by Tanith Rose. UEG Research Committee, composed of active leading researchers in the digestive health field, were consulted for their expertise in gastroenterology throughout. As Committee Chair, I am delighted to announce the publication of the White Book 2 after 2 years of intensive work, including the Executive Summary in this issue of UEG Journal1 Edition and the full analysis on the UEG website.3 What distinguishes digestive diseases from other diseases is their chronic nature. Therefore, the White Book 2 analyses the major socioeconomic burden of the digestive diseases through an international comparative analysis encompassing measures of incidence, prevalence and mortality, trends on the evolution of the diseases and age & sex differences. Modifiable risk factors, like alcohol use, drug use, smoking and high body-mass index (BMI) and their impact on the incidence of digestive diseases burden demonstrate more than ever the importance to act for the implementation of ambitious prevention strategies in the public health policies and regulations. As the White Book 2 highlights, due to strong tobacco control measures, we've already seen a decrease in the burden attributable to smoking, whereas the proportion of digestive disorder burden attributable to high BMI or alcohol use keeps rising in many countries. UEG advocacy calls & actions on nutrition and alcohol4 are therefore of paramount importance. Furthermore, the inequal burden of digestive diseases, between countries but also between individual's social position highlights the significance of the social determinants of health. Other important findings from the White Book 2 include the enormous economic costs to societies that arise as a result of lost productivity due to digestive disease related disability and premature mortality. These costs reflect the high burden of some digestive disease amongst working age populations and highlight the need for actively reducing mortality from digestive diseases.1 Echoing the European Commission's pledge to beat cancer in Europe, UEG Public Affairs and Research Committees have produced several position papers in the past few years to call for action on the prevention, screening5 & treatment of digestive cancers and for an increase in the European research funding6 for these cancers. The White Book 2 emphasises that digestive cancers are responsible for 34% of the total number of cancer related deaths across UEG member countries7 and that numbers of incident cases and deaths continue to rise. One of the strategic objectives of the Research Committee which I am chairing is to increase EU funded digestive health research by providing evidence and advice to funding bodies on priority areas in close liaison with our member societies. The White Book 2 is incremental in providing evidence-based data which will allow to define and advocate for broadly agreed research priorities. It combines a survey on the research priorities and preferences of UEG national society members, answered by 73% of the societies, a bibliometric analysis providing an overview of the distribution of research activity in the field of digestive health, and an analysis of Horizon 2020 funded research projects in digestive disease research. Interestingly, one of the key outcomes identified by the research team is that several digestive diseases which received little Horizon 2020 research funding were highlighted as areas for prioritisation by the national societies. The prevention of digestive diseases, which appears as a significant health determinant in the analysis of the burden, is also identified as an area of prioritisation for research by the societies. In addition, the underfunding of diseases affecting predominantly socio-economically disadvantaged groups, like alcohol-related liver disease, despite the significant burden, mirrors the unequal weight of digestive diseases depending on social positions and countries' development. The White Book 2 represents an important milestone for UEG Research and Public Affairs strategies. It lays the foundations for ambitious advocacy efforts in the coming years based on evidence-based data and will underpin the definition and prioritisation of UEG calls toward policymakers, both at European and national level. It affirms the importance of strong public health policies and adequate research funding and the role of our scientific societies in providing the latest science & expertise to policymakers. Data sharing is not applicable to this article as no new data were created or analysed in this study.