What are we talking about?

OVERDIAGNOSIS means transforming people into patients unnecessarily (i.e. without clear benefit, and with potential for
damage) by identifying problems that were never going to cause harm, or by medicalising ordinary life experiences.

Why is important to
Universal Health Coverage?
A Public Health issue: Dimensions of health coverage (WHO 2010)

Overdiagnosis… “Around 30% of total

health care
spending was waste”.
The Cost of Healthcare.
Financial Institute of Medicine
…it diminishes the quality of protection: 2010
what do
healthcare, over-stretches health Include
other
people have
to pay out-
Reduce cost sharing and fees
systems, steals resources from services of-pocket?

those who are in the greatest need

“There is no way it could
of medical care and undermines Extend to
non-covered
ever meet all demands for
health care conceivable in
population health. Services:
Which services
a consumer market, driven
are covered?
not by needs but by
Population: who is covered? wants”. Julian Tudor Hart.
The political economy of
health care. 2006.

How to prevent
Overdiagnosis and
Overtreatment?
Take the initiative to discuss the potential
Patients
for Overdiagnosis in different settings
and
Public
(professionals organisations, lay people,
health authorities, patients and citizens).

Demand that authorities and funders put

Overdiagnosis on the public agenda and
support research and dissemination of
information about this.

Generally support a professional attitude

of moderation.
Pathirana T, Clark J, Moynihan R. Mapping the drivers of overdiagnosis to
potential solutions. BMJ 2017;358:3879 doi: 10.1136/bmj.j3879

Overdiagnosis Conference regrets the fact that the draft Astana Declaration on Primary Health Care 2018 (From Alma-Ata
towards Universal Health Coverage and the Sustainable Development Goals) makes no reference to the public health and
clinical  challenges of overdiagnosis and overtreatment.  

These challenges include direct harms to patients and citizens, misallocation of resources, and, over the longer term, they
threaten the sustainability of universal healthcare systems and so undermine global health.  

Sustainable health systems must explicitly manage the twin problems of underuse and overuse
What are we talking about it?

!  OVERDIAGNOSIS means transforming people into

patients unnecessarily (i.e. without clear benefit, and
with potential for damage) by identifying problems
that were never going to cause harm, or by
medicalising ordinary life experiences.

!  It has two major causes:

!  Overdetection: to identification of pathologies in healthy
people that would never cause patient-relevant disease
!  Overdefinition of disease:
!  Lowering the threshold for a risk factor without evidence that
doing so helps people feel better or live longer.
!  Expanding disease definitions to include patients with
ambiguous or very mild problems that might be better tackled
outside the healthcare system.
A Public Health issue:
Overdiagnosis…

!  …has an immense impact: it diminishes the quality of

healthcare, over-stretches health systems, consume
resources and undermines population health.
!  …is a public health matter: it does harm to healthy
individuals and steel resources from those who are in the
greatest needs of medical care.
!  … can lead to over-prescription and over-medicalization
contributing to the proliferation of antimicrobial
resistance.
Pathirana T, Clark J, Moynihan R. Mapping the drivers of overdiagnosis to potential solutions.
BMJ 2017;358:3879 doi: 10.1136/bmj.j3879
How to prevent
Overdiagnosis and
Overtreatment?

!  Demand balance, evidence-informed from providers and

authorities in relation to screening.
!  Take the initiative to discuss the potential for
Overdiagnosis in different settings (colleagues,
professionals organisations, lay people,health
authorities,patients and citizens).
!  Demand that authorities and funders put Overdiagnosis
on the public agenda and support research and
dissemination of information about this.
!  Strive to adhere to guidelines and recommendations that
aim at reducing unnecessary healthcare, when such
recommendations exists.
!  Generally support a professional attitude of moderation
among colleagues and students.
 Why is important to Universal
Health Coverage?

“Around 30% of total health

care spending was waste”.
The Cost of Healthcare.
Institute of Medicine, 2010

““There is no way it could

ever meet all demands for
health care conceivable in
a consumer market, driven
not by needs but by
wants”. Julian Tudor Hart.
The political economy of
health care. 2006.
 The Copenhagen Statement.
August 2018

Overdiagnosis Conference regrets the fact that

the draft Astana Declaration on Primary Health
Care 2018 (From Alma-Ata towards Universal
Health Coverage and the Sustainable
Development Goals) makes no reference to the
public health and clinical   challenges of
overdiagnosis and overtreatment.  
These challenges include direct harms to
patients and citizens, misallocation of resources,
and, over the longer term, they threaten the
sustainability of universal healthcare systems
and so undermine global health.  
Sustainable health systems must explicitly
manage the twin problems of underuse and
overuse
Further information

!  https://www.preventingoverdiagnosis.net/?page_id=1176

!  http://www.woncaeurope.org/content/overdiagnosis-
position-paper

!  https://issuu.com/home/published/
overdiagnosis._astana_2018
Thank you¡

!  @sminue
!  sergiominue21@gmail.com