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Charting a new path for global psoriasis care: how to bridge the gap between health and happiness

 

In September 2018, the World Psoriasis Happiness Report 2018 went live.

Its pages told the stories of almost 80,000 people across 21 countries, documenting the often devastating impact that psoriasis has on happiness and general well-being.

Though the report demonstrated many important insights, one thing resounds clearer than most:  

it’s time to rethink our approach to supporting those living with psoriasis. We need to move beyond day-to-day symptom management, and into a broader, more holistic support for mental health in chronic care.

To do this, we need a new psoriasis game-plan.

Closing the gap between mental and physical healthcare

The World Psoriasis Happiness Report 2018 showed beyond refutable doubt that psoriasis undermines people’s happiness.

And not by a small margin.

In fact, in some countries, those living with self-reported severe psoriasis experienced happiness gaps of almost 40% when compared to the national average.

Despite this, though we know that mental and physical health are inextricably linked for those living with chronic conditions, the two areas continue to exist separately within the healthcare system, both at a cultural and institutional level.

That has to change.

The truth is, health is more than just the absence of physical hardship. It’s the sum total of a person’s lived experiences. How they are able to exist and participate in the world around them, as well as how they experience physical symptoms. That means that when a person’s happiness and well-being is so negatively affected by their condition, their overall objective health status is too.

If we’re to fix this, it’s time to close the gap between mental and physical healthcare.

Closer working between healthcare professionals

Though psoriasis is often defined as a physical condition, the World Psoriasis Happiness Report 2018 showed that 1 in 4 people also report to suffer from psychological impacts as a result of their symptoms.

With stats like this, it’s no longer enough to consider and provide care for psychological  and physical conditions separately; we need to consider them two parts of the same whole when establishing psoriasis care plans.

One of the primary means of doing so is through closer working between primary care and mental health professionals.

This could be facilitated, for example, through more joined-up supportive care between healthcare providers, or perhaps through providing psychotherapy for those living with psoriasis so that they have better access to the support they need.

Improved access to training for healthcare providers

According to the World Psoriasis Happiness Report 2018, only 27.3% of all respondents reported that their doctor discussed how psoriasis affects their mental health and general well-being.

This suggests that over two thirds of those living with psoriasis experience the psychological impact of psoriasis in the shadows.

It is therefore imperative that healthcare systems actively equip primary care providers to manage mental and social well-being in their everyday interaction with patients.

Put plainly: we should be asking about mental health as a standard part of psoriasis patient care, and implementing preventative (or reactive) psychological care plans accordingly.

Better established frameworks to capture subjective well being

If included at all, questions on subjective well-being typically focus on aspects of life such as satisfaction with social interactions, but seldom address life as a whole.

Subjective well-being measures, on the other hand, can provide a more holistic and patient-centric method of capturing a sense of general well-being, allowing us to better understand how people living with psoriasis experience their lives.

The issue is, they are unfamiliar and little established among healthcare professionals, making it very difficult to obtain standardised or conclusive insights.

It is therefore vital to support healthcare professionals with better (and more easily implementable) frameworks to capture subjective well-being, and to use these insights to power more effective measures to support general well-being and happiness.

Investing in happiness is a necessity, not a luxury

One of the biggest limiting factors for investing in better psychological interventions for those living with psoriasis is the perceived cost.

However, from a business and societal perspective, people’s happiness is of great importance as it is directly linked to monetary costs and gains.

Every day that people can’t go to work nor give their best efforts erodes productivity, costing companies and society at large significant sums of money. According to the World Health Organization, the estimated global cost of lost productivity due to mental health disorders is $1 trillion dollars annually.

Specific policy measures to target the mental health impact of psoriasis is arguably the cheapest means to counteract the cost of mental health related productivity loss. In fact, attempting to reach the same economic gains through job creation (such as active labor market policies, for example) is estimated to be 3 times more expensive.

More importantly, the net cost of such policies is negative.

When everything is accounted for, the total gains far exceed the total costs of the treatment, by a factor of 4:1.

This means that for every $1 spent on mental health policy measures, society regains $4, a conclusion has been repeatedly supported by the WHO and Global Health Council.

The question is therefore not can society afford to invest in happiness, but can it afford not to?

Establishing more proactive care with early screenings

The World Psoriasis Happiness Report 2018 indicates that, though psoriasis in itself is a non-communicable disease (NCD), having psoriasis strongly increases someone’s risk of developing other NCDs.

Similarly, people with psoriasis have higher rates of environmental risk factors including smoking, alcohol use, obesity and sedentary lifestyles. These are all key risk factors that cause non-communicable diseases (NCDs), making those living with psoriasis potentially far more at risk from preventable conditions.  

Based on these findings, it’s essential to move away from a reactive approach to psoriasis and co-morbidities, and instead develop a health system action plan that is focused on prevention and control.

One ambition of The World Psoriasis Happiness Report 2018 is therefore to encourage healthcare providers to establish early comorbidities screenings for those living with psoriasis, and to provide supportive care focused on developing positive lifestyle habits.

The hope is that these efforts will have a positive impact the growing problem of NCDs, giving the chance of an otherwise long, healthy life for those living with psoriasis.  

Broadening the global conversation around psoriasis

A core objective of the World Psoriasis Happiness Report 2018 is to facilitate better cooperation amongst key drivers in psoriasis care and prevention.  

As the IFPA noted when the World Psoriasis Happiness Report was published:

“These data points can be a key driver in broadening the global conversation around the impact of psoriasis beyond scientists and clinicians, and will allow advocacy groups to facilitate a more compelling conversation with policy makers”.

The voices and stories that power the WPHR are both profound and compelling. Knowing the human cost of psoriasis, it’s clear that we have to work towards a new approach.

Our goal is that patient associations, policy makers and healthcare professionals use the insights from the report to work together, to give subjective well-being a more prominent position on the global health agenda.

Promisingly, some patient associations are already beginning to use the World Psoriasis Happiness Report data as a planning tool.

In 2017, Japan ranked 18th out of the 19 countries in our global Psoriasis Happiness Index. This year, the Japanese Association for Public Awareness of Psoriasis, INSPIRE JAPAN WPD, has been established to help people with psoriasis connect to peers, get accurate information and find appropriate treatment.

“We were so surprised that Japan had the second worst ranking among 19 countries in the World Psoriasis Happiness Report 2017. Our vision is “a world where no one suffers from psoriasis” – this is the same as IFPA. We think that the psoriasis ranking is one of the most important metrics for how much we can hit our goal.

Mr. Masanori OKUSE

The Japanese Association for Public Awareness of Psoriasis

Be part of the change you wish to see

One voice alone can’t change the world, but many voices just might.

Our message is clear: if you live with psoriasis, you no longer have to exist in the shadows. Your life, your happiness, your overall well-being: it matters.

You can help further this message by and show your support by sharing PsoHappy social posts and updates with friends; use the hashtags #ItStartsWithMe.

We also invite those living with psoriasis to share their stories in our publications and on our blog. Check out our new ambassador video or submit your own by contacting us at hello@psohappy.org

 

PsoHappy explores how psoriasis affects happiness and well-being. Make your voice heard by taking our surveys about different aspects of living with psoriasis

 

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