Chronic Disease . . .
the Public Health Challenge of the 21st Century
The United States spends significantly more on health care than any other nation. In 2006, our health care expenditure was over $7,000 per person, more than twice the average of 29 other developed countries. We also have one of the fastest growth rates in health spending, tripling our expenditures since 1990. Yet the average life expectancy in the United States is far below many other nations that spend less on health care each year.
As a nation, more than 75% of our health care spending is on people with chronic conditions. These persistent conditions - the nation's leading causes of death and disability - leave in their wake deaths that could have been prevented, lifelong disability, compromised quality of life, and burgeoning health care costs.
The scope and severity of the chronic disease problem has not escaped the public's attention. More than two-thirds of all adults believe that the U.S. health care system should place more emphasis on chronic disease preventive care, and more than 4 in 5 Americans (84%) favor public funding for such prevention programs.
What are These Chronic Conditions?
Tackling chronic disease requires a closer look at the major conditions that affect our nation - namely, heart disease and stroke, cancer, diabetes, arthritis, obesity, respiratory diseases, and oral conditions.
Heart Disease and Stroke
The good news is that since 1999, death rates for coronary heart disease and stroke have declined 20.8% and 24.4%, respectively. In addition, the percentage of adults with high cholesterol, a major risk factor for heart disease, has been cut by almost half since the early 1960s.
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Cancer
During the past two decades, tremendous progress has been made in developing and using effective cancer prevention strategies, early detection interventions, and cancer treatments. Largely through public health efforts targeting screening, breast cancer deaths among women decreased by 2% per year from 1998 to 2005, and deaths from colorectal cancer decreased among both men and women by 4% per year from 1995 to 2005.
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Diabetes
Tremendous progress has been made in managing diabetes and its complications. Because of public health efforts, higher percentages of people with diabetes are monitoring their blood sugar daily and receiving, through health professionals, annual foot exams, eye exams, and influenza and pneumococcal vaccinations. The incidence of treatment for diabetes-related end-stage renal disease declined 21% from 1997 to 2002, and the prevalence of visual impairment among people with diabetes decreased as well, from 24% in 1997 to 18% in 2005.
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Arthritis
Arthritis is the nation's most common cause of disability, affecting 1 of every 5 adults. As the U.S. population ages, the number of adults with doctor-diagnosed arthritis is projected to increase from 46 million to 67 million by 2030, and 25 million of these individuals will have limited activity as a result. Considerable progress has been made in raising awareness and understanding of effective, evidence-based messages and interventions (such as physical activity) to decrease disability and increase quality of life among those with arthritis.
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Obesity
Obesity has emerged as a priority in chronic disease prevention and has been linked to increased risk for heart disease, high blood pressure, type 2 diabetes, arthritis-related disability, and some cancers. After a quarter-century of increasing rates, obesity prevalence among children and adults appears to be leveling.
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Respiratory Diseases
Smoking is the primary risk factor for chronic respiratory diseases, such as emphysema and chronic bronchitis, both of which are major conditions of chronic obstructive pulmonary disease (COPD). COPD, as well as lung cancer, could become relatively uncommon in future generations if smoking rates were substantially reduced.
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Oral Conditions
Mouth and throat diseases - such as tooth decay, periodontal (gum) disease, and oral cancers-cause pain and disability for millions of Americans each year. The good news is that remarkable progress has been made in oral health over the past few decades. The baby boomer generation will be the first in which the majority will maintain their natural teeth over their entire lifetime, having benefited from water fluoridation and fluoride toothpastes. In addition, the use of dental sealants over the past several decades has significantly improved the oral health of children.
Click here for oral Fitness and Dental Readiness Resources.
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What are the Causes?
Lack of Physical Activity
Regular physical activity is one of the most important things a person can do to stay healthy. Not only will physical activity increase one's chances of living longer - it can also help control weight; reduce risks for cardiovascular disease, type 2 diabetes, metabolic syndrome, and some cancers; strengthen bones and muscles; improve mental health and mood; and improve ability to do daily activities and prevent falls among older adults.
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Poor Nutrition
Good nutrition can help lower risk for many chronic diseases, including heart disease, stroke, some cancers, diabetes, and osteoporosis. Increased consumption of fruits and vegetables helps reduce the risk for heart disease and certain cancers as well. Managing weight is all about balance - balancing the number of calories consumed with the number of calories the body uses or "burns off."
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Tobacco Use
Since 1964, an ongoing series of Surgeon General's reports on smoking and health has concluded that tobacco use is the single most avoidable cause of disease, disability, and death in the United States. The tobacco use epidemic can be stopped. Evidence-based, statewide tobacco control programs that are comprehensive, sustained, and accountable have been shown to reduce smoking rates, tobacco-related deaths, and disease caused by smoking.
For information on quitting smoking visit the Stop Tobacco Shop.
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Excessive Alcohol Consumption
Excessive alcohol use is the nation's third leading lifestyle-related cause of death, and is associated with a wide range of health and social problems, including acute myocardial infarction, unintended pregnancy, and interpersonal violence. The current Dietary Guidelines for Americans recommends that people who choose to drink alcoholic beverages do so sensibly and in moderation, defined as up to 1 drink per day for women and up to 2 drinks per day for men. These guidelines also specify that some people should not drink alcoholic beverages at all, including underage youth.
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