more than 133 million americans -- 45 percent of the population

The Almanac of Chronic Disease

2008 Edition

2

Table of Contents

I. The Human Cost Today

II. The Economic Cost Today

III. The Cost Tomorrow

IV. Opportunity for Improvement

V. Understanding of the Problem and Support for Change

3

Chapter One: The Human Cost Today

Introduction:

Chronic diseases are a significant problem in the United States, accounting for many of the most prevalent and costly illnesses that affect Americans. More than 133 million Americans, or 45 percent of the population, have at least one chronic condition. These conditions include arthritis, asthma, cancer, cardiovascular (heart) disease, depression and diabetes, though these are only a few of many chronic illnesses that negatively impact the lives of Americans.

Many chronic diseases are caused or exacerbated by poor nutrition, lack of exercise, smoking and other lifestyle choices. As a result of these factors, as well as a lack of emphasis on preventive care, incidence rates of chronic disease have increased substantially over the last two decades. Risk factors like obesity are also on the rise. Since 1980, obesity rates have increased 250 percent, now affecting 71 million Americans. This has tremendous implications for future generations; for example, it is predicted that 1 in 3 children born in 2000 will develop diabetes over the course of their lives, given current trends in overweight and obesity.

Not surprisingly, chronic diseases have become the leading cause of death and disability in the United States. Seven out of every 10 deaths are attributable to chronic disease, and illnesses like heart disease and cancer top the list of most common causes of death. Minority populations are often disproportionately impacted by chronic disease, with African Americans and Hispanics often 1.5 to 2 times more likely to have a certain condition than their white counterparts.

4

Nearly half of Americans have one or more chronic diseases

Total U.S. population

45% -- 133 million

Americans –have one or

more

Source: Wu S, Green A. Projection of Chronic Illness Prevalence and Cost Inflation. RAND Corporation, October 2000.

5

Many Americans have more than one chronic health problem

Source: Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November 2007.

23

12

64 4

0%

5%

10%

15%

20%

25%

30%

1 2 3 4 5 plus

Number of chronic conditions

Percent of all Americans with chronic health conditions

6

Pulmonary conditions are among the most prevalent types of chronic health problems

49.2

36.8

30.3

19.1

13.7

10.6

2.4

0 10 20 30 40 50 60 70

Stroke

Cancers

Diabetes

Heart disease

Mental disorders

Hypertension

Pulmonary conditions

Number (in millions) of Americans reporting specific chronic conditions*

Million

*This study evaluated the burden of seven of the most common chronic diseases/conditions (cancer, diabetes, heart disease, hypertension, mental disorders, pulmonary conditions, and stroke.

Source: DeVol, R, Bedroussian, A, et al. An Unhealthy America: The Economic Burden of Chronic Disease. The Milken Institute. October 2007. Full report and methodology available at: www.chronicdiseaseimpact.com.

http://www.chronicdiseaseimpact.com/

7

Mental health conditions, such as depression, dramatically increase disability* when paired with

other chronic health conditions

Degree of disability due to select chronic diseases

3.56 7 7

0

5

10

15

20

25

Degree of disability due to select chronic diseases plus depression

Source: WHO World Health Survey, Moussavi, et al, (2007) Lancet

Diabetes Arthritis Angina Asthma Diabetes Arthritis Angina Asthma

Deg

ree

of d

isab

ility

*Disability is the measure of difficulty completing important and ordinary life tasks and roles.

23

17

2019

0

5

10

15

20

25

8

Older adults are more likely to have chronic health conditions, but Americans of all ages are affected

Percent of U.S. population with chronic conditions

26

40

68

90

615

42

72

0%

20%

40%

60%

80%

100%

0-19 20-44 45-64 65+

1 or more chronicconditions

2 or more chronicconditions

Ages


9

Certain chronic diseases, such as diabetes, are more prevalent among minority populations

8.7

13.3

9.5

22.6

0%

5%

10%

15%

20%

25%

30%

White AfricanAmerican

Hispanic American Indianand Alaskan

Native

Estimated age-adjusted total prevalence of diabetes in people aged 20 years or older – United States, 2005

Source: American Diabetes Association. Total Prevalence of Diabetes and Pre-diabetes. Accessed at: https://www.diabetes.org/diabetes-statistics/prevalence.jsp

10

Diagnosis of many chronic diseases is on the rise in the U.S.

3.3

7.4

0%

1%

2%

3%

4%

5%

6%

7%

8%

1980 2005

Percent of U.S. adult population diagnosed with diabetes

3

5.5

6.7

0%

1%

2%

3%

4%

5%

6%

7%

8%

1970 1996 2003

Percent of U.S. adult population diagnosed with asthma

Also, U.S. Centers for Disease Control & Prevention. National Surveillance for Asthma --- United States, 1980—2004. Accessed at: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5608a1.htm

Source: U.S. Centers for Disease Control & Prevention. Crude and Age-Adjusted Incidence of Diagnosed Diabetes per 1000 Population Aged 18-79 Years, United States, 1980–2005. Accessed at: http://www.cdc.gov/diabetes/statistics/incidence/fig2.htm

11Centers for Disease Control and Prevention , Prevalence of Diabetes and Impaired Fasting Glucose in Adults - United States, 1999-2000, MMWR, 2003. Vol. 52(35), p. 833.

One-third of people with diabetes, or

nearly 6 million people, don’t

know they have it

Many cases of chronic diseases go undiagnosed

Total U.S. adults with diabetes = 18 million

A survey conducted by the Centers for Disease Control and Prevention (CDC) found that nearly one third of people with diabetes don’t know they have it

33% undiagnosed

12

Other cases of chronic disease are diagnosed, but not well-controlled

Unaware, 24%

Aware, Not Treated, 11%

Controlled, 31%

Treated, Not Controlled, 34%

Source: Presentation by David Cutler. Alliance for Health Reform Novartis/NIHCM Briefing. March 28, 2008. Alliance for Health Reform Novartis/NIHCM Briefing. March 28, 2008. Original sources: NHANESOriginal sources: NHANES

Percent of U.S. adults with hypertension

13

And in other cases, chronic disease risk factors are starting to be better diagnosed and treated, although

there is still room for improvement

Unaware, 61%

Aware, not Treated,

28%

Treated, not

Controlled, 8%

Controlled, 4%

Unaware, 37%

Aware, not Treated,

22%

Treated, not

Controlled, 16%

Controlled, 25%

1988-94 1999-2004

Source: Presentation by David Cutler. Alliance for Health Reform Novartis/NIHCM Briefing. March 28, 2008. Alliance for Health Reform Novartis/NIHCM Briefing. March 28, 2008. Original sources: NHANESOriginal sources: NHANES

Percent of U.S. adults with high cholesterol

Please note that percentage is slightly more than 100 due to rounding

14

Rates of obesity -- one of the key risk factors for a number of chronic health problems -- have increased

substantially

No data <10% 10%-14%

1985

No data <10% 10%-14% 15%-19% 20%-24% 25%-29% >30%

Percent of U.S. adults who are obese*

2005

Source: Thorpe K, Florence, C, Howard, D, Joski, P. The Impact of Obesity in Rising Medical Spending. Health Affairs. 2004.

15

The share of children who are overweight has more than doubled in the U.S. over the past two decades

5 5

14

18.817.4

6.5

0%

5%

10%

15%

20%

25%

2-5yrs 6-11yrs 12-19yrs

1980

2002

Percent of children who are overweight

Source: Centers for Disease Control and Prevention. Childhood Overweight. Accessed at: http://www.cdc.gov/nccdphp/dnpa/obesity/childhood/

16

The diagnosis of childhood chronic diseases has almost quadrupled over the past four decades

1.8

7

0%

1%

2%

3%

4%

5%

6%

7%

8%

1960 2004

Percent of U.S. children diagnosed with a chronic illness

Source: Perrin, James M.; Bloom, Sheila R.; Gortmaker, Steven L. The Increase of Childhood Chronic Conditions in the United States. Journal of the American Medical Association

17

The increase in childhood obesity is placing the next generation at great risk for developing chronic diseases

earlier in life

Children born in the U.S. in 2000

*childhood overweight and obesity

One third = portion of who will develop diabetes over

their lifetime, given current trends in the

share who are overweight or obese

Source: Laino C. One in three kids will develop diabetes. Web MD. June 16, 2003. Available at:http://www.webmd.com/content/article/66/79851.htm. Accessed July 31 ,2006.

18

Many Americans are not getting enough physical activity, a key risk factor for chronic diseases and

obesity

Percent of U.S. adults who do NOT get the recommended amount of physical activity

4349 50 54

60

0%

20%

40%

60%

80%

100%

18–24 25–34 35–44 45–64 65+

Source: Centers for Disease Control and Prevention. Prevalence of Regular Physical Activity Among Adults --- United States, 2001 and 2005. Accessed at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5646a1.htm?s_cid=mm5646a1_e

Age

19

Minority Americans are less likely to get enough physical activity, which may contribute to higher levels

of chronic disease among these groups

50 48

645553 545860

0%

20%

40%

60%

80%

100%

Women Men

Race/Ethnicity/Gender

White

Black

Hispanic

Other

Percent of U.S. adults who are NOT getting recommended levels of exercise

Source: Centers for Disease Control and Prevention. Prevalence of Regular Physical Activity Among Adults --- United States, 2001 and 2005. Accessed at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5646a1.htm?s_cid=mm5646a1_e

20

States in the South and New England have the highest rates of chronic diseases*

Top QuartileSecond Third Bottom Quartile

States in the top quartile have the lowest rates of seven common chronic diseases*This study evaluated the burden of seven of the most common chronic diseases/conditions (cancer, diabetes, heart disease, hypertension, mental disorders, pulmonary conditions, and stroke.



21

Chronic diseases are the leading cause of death in the U.S.

Chronic disease is

responsible for seven out of every 10 deaths each

year

Top 5 Causes of Death (1980, 2004)

1980 2004

1 Heart disease Heart disease

2 Cancer Cancer

3 Cerebrovascular diseases (Stroke, hypertension)

Cerebrovascular diseases (Stroke, hypertension)

4 Unintentional injury

Chronic lower respiratory diseases

5 Chronic obstructive pulmonary disease

Unintentional injury

Chronic disease accounts for four of the top five

causes of death

Source: Centers for Disease Control and Prevention. Chronic Disease Overview page. Available at: http://www.cdc.gov/nccdphp/overview.htm. Accessed April 6, 2007.

Source: Centers for Disease Control and Prevention. Health, United States, 2007. http://www.cdc.gov/nchs/data/hus/hus07.pdf#summary

http://www.cdc.gov/nccdphp/overview.htm


22

Family caregivers are a critical support structure for Americans with chronic illnesses, and the U.S.

health care system

In any given year, more than 50 million Americans find themselves in a caregiving role

Family caregivers provide the vast

majority (80 percent) of all long-term care

services for those with a chronic illness or

disability

Almost one in five (17 percent) family caregivers provide 40 hours of care a

week or more

Source: Thompson L., “Long-term care: Support for family caregivers [Issue Brief].” Washington, DC: Georgetown University,2004 and U.S. Agency for Healthcare Research and Quality. Long-Term Care Financing Project, Long-term Care Users Rangein Age and Most Do Not Live in Nursing Homes. November 8, 2000.

23

Caregiving can take a toll on caregivers' health

Source: Cannuscio CC, Jones C, Kawachi I, Colditz G.A., Berkman L and Rimm E, “Reverberation of family illness: A longitudinal assessment of informal caregiver and mental health status in the nurses’ health study.” American Journal of Public Health. 92:305-1311, 2002. Also, Glaser, JK and Glaser, R. “Chronic stress and age-related increases in the proinflammatory cytokine IL-6.” Proceedings of the National Academy of Sciences, June 30, 2003. Also, Epel ES, Dept of Psychiatry, Univ. of California, San Francisco, et al, From the Proceedings of the National Academy of Science, Dec 7, 2004, Vol. 101, No. 49.

Noncaregivers Children ofaging parents

Spousalcaregivers

Family caregivers experiencing

extreme stress have been shown to have weakened immune systems, be more prone to chronic

diseases themselves and age

prematurely.

This level of stress can take as much as 10 years off a family

caregiver's life.

Children caring for aging parents are twice as likely as non-caregivers to suffer from depression. Spousal are

six times as likely to suffer from depression.

24

Chapter Two: The Economic Cost Today

Introduction

Chronic diseases are at the root of a significant portion of rising health care costs. About two-thirds of the rise in health care spending over the last two decades is due to the rise in treated rates of chronic disease. In addition, the vast majority of current spending is for treatment of Americans with one or more chronic conditions. Indeed, more than 75 percent of the approximately $2 trillion Americans spend each year on health care is spent on chronic diseases, and public health programs like Medicare and Medicaid are seeing sizable portions of their budget devoted to treatment of chronic diseases and complications from those conditions.

But direct health care costs represent only a quarter of the total cost of chronic diseases. Indirect costs such as absenteeism and presenteeism* cost businesses – and our economy -- $1 trillion a year. Every year, millions of work days are missed because employees are suffering themselves from a chronic disease, or they have to care for a loved one who is ill.

*Presenteeism is defined as lost productivity that occurs when employees come to work but perform below par due to any kind of illness.

25

Three in four dollars spent on health care in the U.S. are for patients with one or more chronic conditions

25%

75%

Health care costs associated with

patients with one or more chronic

diseases =~$1.58 trillion

Source: Centers for Disease Control and Prevention. Chronic Disease Overview page. Available at: http://www.cdc.gov/nccdphp/overview.htm. Accessed April 6, 2007.

Total U.S. health spending in 2006 = $2.1 trillion



26

Within public health problems, patients with chronic diseases represent an even higher percentage of

spending

More than 96 cents of every dollar spent in Medicare…

…and 83 cents of every dollar spent in Medicaid

Source: Partnership for Solutions. Chronic Conditions: Making the Case for Ongoing Care. September 2004 Update. Available at: http://www.rwjf.org/files/research/Chronic%20Conditions%20Chartbook%209-2004.ppt. Accessed on April 17, 2007.

Share spent on patients with chronic diseases

27

Not surprisingly, people with chronic conditions are the heaviest users of health

care services

99

92

82

79

0% 20% 40% 60% 80% 100%

Physician Visits

Impatient Hospital Stays

Prescription Drugs

Home Health Care Visits

Percent of services used by U.S. adults with chronic conditions


28

Increases in the prevalence and treatment intensity of chronic disease are responsible for about two-thirds of

the increase in health care costs over the past two decades

$0

$100

$200

$300

$400

$500

$600

$700

'87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00

~$211 billion

Level of health spending among thenoninstitutionalized U.S. population, 1987–2000

$313.5

$627.9

= Increase attributable to rise in prevalence of treated chronic disease

(in billions of nominal dollars)

Years

Source: Thorpe K. The Rise In Health Care Spending And What To Do About It. Health Affairs. 2005;6:1436-1445. Also, Thorpe K, Florence CS, Joski P. Which Medical Conditions Account For The Rise In Health Care Spending?

29

The doubling of obesity is responsible for about one-third of the rise in health care costs since the mid-

1980s

No data <10% 10%-14%

1985

No data <10% 10%-14% 15%-19% 20%-24% 25%-29% >30%

Percent of U.S. adults who are obese*

2005

*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person

Source: Thorpe K, Florence, C, Howard, D, Joski, P. The Impact of Obesity in Rising Medical Spending. Health Affairs. 2004. Also, Centers for Disease Control and Prevention. U.S. Obesity Trends 1985-2000. Available at: http://www.cdc.gov/nccdphp/dnpa/obesity/trend.maps

30

Health care spending related to chronic diseases is dwarfed by the indirect costs of these health

problems

Direct costs represent about a fifth of the total cost burden of chronic diseases

$277 billion 21%

$1.0 trillion79%

Indirect costs amount to four-fifths of the total burden

Total cost burden in 2003 for seven common chronic diseases*

Direct costs = Health care costs associated with treatment of chronic disease

Indirect costs = Productivity losses such as absenteeism and presenteeism associated with people with chronic diseases




31

Cancer and hypertension are among the most costly chronic conditions, accounting for over $500 billion

annually in treatment expenditures and lost economic output

$48

$33

$46

$65

$45

$271

$280

$171

$105

$94

$105

$22

$27

$0 $50 $100 $150 $200 $250 $300 $350 $400

Cancers

Hypertension

Mental Disorders

Heart Disease

Pulmonary Conditions

Diabetes

Stroke

Treatment Expenditures Lost Economic Output

Treatment expenditures and lost economic output (in billions)per chronic condition*




32

Presenteeism is responsible for the largest share of lost economic output associated with chronic health

problems

Lost Workdays

Caregiver,

$11 billion

Presenteesism Caregiver,

$80 billion

Lost Workdays Individual,

$127 billion

Presenteesism

Individual,

$828 billion

Presenteeism is defined as lost

productivity that occurs when

employees come to work but

perform below par due to any kind of illness.

Cost of chronic diseases by category, 2003

Total = ~$1 trillion




33

When it comes to presenteeism, arthritis, hypertension, and depression are among the most

costly conditions

Estimated average annual cost of presenteeism per employee with condition

$33

$71$72$76

$159

$189

$222$246$247$252

$0

$100

$200

$300

A rth ritis H yp e rte n sio n Mig ra in /H e a d a c h e D e p re ssio n /S a d n e ss/Me n ta l Illn e ss A lle rg y Mig ra in e /H e a d a c h e D ia b e te s A n y C a n c e r A sth ma H e a rt D ise a se R e sp ira to ry D iso rd e rs

Co

st

pe

r E

mp

loy

ee

wit

h C

on

dit

ion

Source: Goetzel, R.Z., et al. (2004). Health, Absence, Disability, and Presenteeism Cost Estimates of Certain Physical and Mental Health Conditions Affecting U.S. Employers. Journal of Occupational and Environmental Medicine, 46(4), 398-412.

Taken from: American Hospital Association. Trendwatch. Summer 2007. Accessed at: http://www.aha.org/aha/trendwatch/2007/twoct2007health.ppt

Arthritis Hypertension Depression/Sadness/

Mental Illness

Allergy Migraine/Headache

Diabetes Any Cancer

Asthma Heart Disease

Respiratory Disorders

34

Depression and stress are the most common causes of absenteeism

25.6

16.914.7

12.0 10.78.2 6.8 5.9

2.0 0.90

10

20

30

40

50

60

Da

ys

pe

r Y

ea

r A

bs

en

t (L

ow

, Av

era

ge

, Hig

h)

Number of days absent per affected individual per year due to 10 conditions, 1997-1999

Source: Goetzel, R.Z., et al. (2004). Health, Absence, Disability, and Presenteeism Cost Estimates of Certain Physical and Mental Health Conditions Affecting U.S. Employers. Journal of Occupational and Environmental Medicine, 46(4), 398-412.


Depression/Sadness/

Mental Illness

Any Cancer

Respiratory Disorders

Asthma Migraine/Headache

Allergy Heart Disease

Arthritis Diabetes Hypertension

35

… And mental illnesses, when comorbid* with other chronic diseases, significantly decrease work

productivity

0

1

2

3

4

Hypertension Arthritis Asthma UlcersAv

era

ge

Nu

mb

er

of

Imp

air

ed

Da

ys

pe

r M

on

th

Chronic Disease

Chronic Disease and Mental Illness

Source: Kessler, RC, Ormel, J, Demler, O, et al. Comorbid Mental Disorders Account for the Role Impairment of Commonly Occurring Chronic Physical Disorders: Results From the National Comorbidity Survey. Journal of Occupational & Environmental Medicine. 45(12):1257-1266, December 2003.

*Cormorbidity is the condition of having two or more diseases at the same time.

Number of 30-day role impairment days associated with pure and comorbid* chronic illnesses

(Role impairment = sickness absence days plus work cut-back days)

36

Caregiving costs workers and employers

Employers can lose as much as $33 billion each year due to employees' need to care for loved

ones 50 years of age and older

Source: Disability and American Families: 2000, Census 2000 Special Reports, July 2005. and Drs. Altman, Cooper and Cunningham, “The Case of Disability in the Family: Impact on Health Care Utilization and Expenditures for Non-disabled Members,” Milbank Quarterly 77 (1) pages 39 – 75, 1999. Also, Stucki BR and Mulvey J, “Can Aging Baby Boomers Avoid the Nursing Home? Long-term Care Insurance for Aging in Place.” American Council of Life Insurers. March 2000. Also, Metlife Mature Market Institute and National Alliance for Caregiving, MetLife. Caregiving Cost Study: Productivity Losses to U.S. Business. July 2006.

Caregiving families tend to have incomes that are

$15,000 less than noncaregiving families, yet they spend 2.5 times more on out of pocket medical

expenses.

In 2000, working family caregivers lost $109 per day in wages and health benefits due to the need to provide full time care

at home.

37

Chapter Three: The Cost Tomorrow

Introduction:

While chronic diseases exact a huge toll on Americans today, the future is even more troubling. Over the next 15 years, the prevalence of chronic conditions in the U.S. is expected to rise dramatically. According to a study by the Milken Institute, there will be 230 million reported cases of chronic disease in 2023, an increase of 42 percent from 2003. Cases of cancer, diabetes and mental disorders are expected to rise most substantially, by 53 to 60 percent per illness. In addition, the number of obese Americans, currently one third of the total population, is also projected to increase. By the year 2015, it is predicted that 75 percent of Americans will be obese, significantly contributing to the rise in chronic illnesses.

Indeed, if current U.S. health trends continue, the results could be catastrophic for future generations, the health care system and the economy. Without immediate focus on prevention, the direct and indirect costs of chronic diseases are predicted to grow exponentially. Research has shown that, if left unchecked, chronic conditions will cost the U.S. economy over $4.1 trillion annually in treatment expenditures and lost economic output by the year 2023. Certain diseases, like heart disease and cancers, will be the most costly.

38

By the year 2023, the incidence of chronic disease is expected to rise dramatically

6254 53

41 3931 29

0%

20%

40%

60%

80%

100%

Cance

rs

Men

tal D

isord

ers

Diabet

es

Heart

Disea

se

Hyper

tens

ion

Pulm

onary

Conditi

ons

Stroke

Projected rise in cases of seven of the most common chronic diseases, 2003-2023*

Source: DeVol, R, Bedroussian, A, et al. An Unhealthy America: The Economic Burden of Chronic Disease. The Milken Institute. October 2007. Full report available at: www.chronicdiseaseimpact.com. Note: Statistics only include data for top seven chronic diseases



39

The rate of obesity is also expected to increase, and contribute to rising rates of chronic diseases

13

3241

0%

20%

40%

60%

80%

100%

Year

By 2015, it is predicted that 41 percent of Americans will be obese

1960 2004 2015

Source: Wang, Y and Beydoun, M. The Obesity Epidemic in the United States—Gender, Age, Socioeconomic, Racial/Ethnic, and Geographic Characteristics: A Systematic Review and Meta-Regression Analysis. Epidemiologic Review. 2007 29(1):6-28; doi:10.1093/epirev/mxm007

By 2015 without major changes, researchers predict 75 percent of adults and 24 percent of children will be

overweight or obese

40

If left unchecked, chronic diseases will cost our economy over $4.1 trillion by the year

2023…

$0$500

$1,000$1,500$2,000$2,500$3,000$3,500$4,000$4,500

2003

2006

2009

2012

2015

2018

2021

Lost Economic Output

Treatment Expenditures

Projected costs associated with seven of the most common chronic diseases*




41

…And could cost the U.S. almost $6 trillion in lost economic output by 2050

0

1

2

3

4

5

6

2005

2010

2015

2020

2025

2030

2035

2040

2045

2050

$US

Tri

llio

ns


Projected lost economic output associated with seven of the most common chronic diseases*



42

Chapter Four: Opportunity for Improvement

Introduction:

Right now, far too little is being invested in improving Americans’ health and effectively preventing and managing common and costly chronic health problems. In an average year, the U.S. spends less than $10 per person on prevention -- about the same amount of money as a single movie ticket costs in many places in the U.S.!

Improvements in personal health behaviors, investment by business and the health care system in population health improvement could save millions of lives, and trillions of dollars. By the year 2023, the U.S. could save over $1 trillion through investing in prevention, mostly by reducing indirect costs of chronic health problems, such as absenteeism and presenteeism.

43

But simple changes in behaviors could lead to significant decreases in cases of common and costly

chronic diseases

The Centers for Disease Control and Prevention (CDC) estimates up to…

…could be prevented if only Americans were to do three things: Stop smoking Start eating healthy Get in shape

80% of type 2 diabetes 40% of cancer

80% of heart disease and stroke

Source: Mensah G. Global and Domestic Health Priorities: Spotlight on Chronic Disease. National Business Group on Health Webinar. May 23, 2006. Available at: http://www.businessgrouphealth.org/opportunities/webinar052306chronicdiseases.pdf. Accessed April 17, 2007.

44

Increasing the use of common preventive care services could save 100,000 lives each year in the United States

alone

50

28

50

37

67

9090 90 90 90

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Daily dose of aspirin Smokers who areadvised by health

professional to quitand offered

medication or otherassistance

Adults age 50+ who areup to date with any

recommendedscreening for

colorectal cancer

Flu immunization forpeople 65+

Breast cancerscreening for women

age 40 and older

Current rates Rates needed to save 100,000 lives annually

Increasing the use of just 5 preventive services to 90 percent from their current rates would save more than 100,000 lives each year in the U.S.

Target rate for use of service

Source: Partnership for Prevention. Preventive Care: A National Profile on Use, Disparities, and Health Benefits. August 2007. Accessed at: http://www.prevent.org/content/view/129/72

45

There is also substantial room for improvement in treating chronically ill patients to prevent further

complications

Chronically ill patients receive only 56% of the clinically recommended preventive health care services

Source: McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. New England Journal of Medicine 2003;348:2635-264.

Only half receive

appropriate preventive

care

46

Many adults with serious chronic diseases feel they do not receive adequate care for their conditions

43

59

71

57

46 46

0%

10%

20%

30%

40%

50%

60%

70%

80%

White Non-White Hispanic Uninsured Insured Total


Percent of U.S. adults with serious chronic conditions who believe they do NOT receive needed treatment

Distribution by select group

47

Patients with chronic illness often see multiple health care providers, and this can make

coordination of care complicated

1 Physician 16%

2 Physicians 26%

3 Physicians23%

4 Physicians15%

5 Physicians6%

6+ Physicians11%

No Doctors3%


Number of different physicians seen by people with serious chronic conditions

48

Conflicting or confusing information can be a serious problem for Americans with chronic diseases

14

16

17

18

0% 5% 10% 15% 20%

Received differentdiagnoses form different

providers

Received information aboutdrug interactions upon

filling prescription

Received conflictinginformation from providers

Had duplicate tests orprocedures

Percent of U.S. adults with chronic health problems reporting that they…


49

Non-white Americans often receive a different level of treatment for their chronic conditions

Percent of U.S. adults with serious chronic conditions who responded "sometimes" or "often" to the following:

32

25 25

2118

15

0%

5%

10%

15%

20%

25%

30%

35%

ReceivedConflicting Advice

ReceivedDuplicate Tests

Given ConflictingPrescriptions

Non-White

White


50

Physicians in the U.S. believe patients with chronic conditions often have problems accessing care

84

80

78

75

65

56

55

53

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Mental Health Care

Adequate Health Insurance

Respite Care for Family

Patient Special Education or Training

Prescription Drugs

Medical Specialists

Other Health Care Professionals

Primary Care Doctors


Percent of physicians who believe access is difficult or very difficult for people with chronic conditions in the following areas:

51

Workplace health promotion programs have been shown to reduce health care costs, increase

productivity and reduce absenteeism

-27%

-28%

-30%

-31

-30

-29

-28

-27

-26

-25

Ave

rag

e C

han

ge

Health costs

Absenteeism

Workers’ comp./ disability management

claims costs

Average percent change in employers’ costs resulting from workplace health promotion and wellness programs

Source: Chapman, L. (2003). Meta-evaluation of Worksite Health Promotion Economic Return Studies. Art of Health Promotion Newsletter, 6(6).


52

By the year 2023, the U.S. can save over $1 trillion through investing in prevention, mostly in indirect

costs*

$0

$200

$400

$600

$800

$1,000

$1,200

2004

2006

2008

2010

2012

2014

2016

2018

2020

2022

Lost economic output (indirect)

Treatment expenditures (direct)

*This study evaluated the burden of seven of the most common chronic diseases/conditions (cancer, diabetes, heart disease, hypertension, mental disorders, pulmonary conditions, and stroke. Alternative assumptions on the future path of chronic-disease incidence, prevalence and cost were developed based on best practices in prevention, early detection and new innovations in disease treatment and management.



53

Investing in prevention will save the U.S. billions of dollars in direct and indirect health costs

$696

$731

$587

$292

$340

$310

$74

$410

$196

$116

$213

$90

$24

$73

$0 $400 $800 $1200

Cancers

Hypertension

Mental Disorders

Heart Disease

Diabetes

Pulmonary Conditions

Stroke

Billions

Alternate future Costs that could be avoided through prevention

Costs of chronic disease (in billions) in 2023 due to treatment expenditures and lost economic output



54

Chapter Five: Understanding of the Problem and Support for

ChangeIntroduction:

As Americans look to choose their next president, health care is the domestic issue they want to hear candidates discuss. While many Americans are interested in hearing about how candidates plan to improve access to care and cover the uninsured, in particular, they want to know what the next president will do to make health care more affordable. Perhaps this is not surprising given the fact that surveys have shown that Americans are very concerned about increases in health insurance premiums and the amount they will pay in out-of-pocket health care expenses.

Despite the significant role that chronic diseases play in contributing to health care spending and deaths in the U.S., many Americans do not understand the extent or scope of the problem. Still, they recognize that something must be done to address the unchecked rise in chronic disease, and the vast majority suggest that this is an issue they want the next president to address.

Americans believe that access to care is an important factor that must be considered when addressing how to reduce problems with chronic disease. They strongly support increasing the share of health care dollars devoted to prevention and endorse policies that change the focus of health care to promoting health and wellness, instead of just treating illness after it occurs.

55

In 2008, health care is one of the top domestic issues that the public wants to hear presidential candidates

talk about

Total Republican Democrat Independent

Iraq 49 49 53 47

Economy 42 33 50 40

Health Care 23 19 29 18

Percent saying that they want candidates to talk about…

Source: Kaiser Family Foundation. Kaiser Health Tracking Poll: Election 2008 – April 2008. Accessed at: http://www.kff.org/kaiserpolls/7772.cfm

56

When it comes to health care, Americans say they want the candidates to talk about how to reduce

costs

Total Republican Democrat Independent

Reducing the costs of health care and health insurance 41 43 35 46

Expanding health insurance coverage for the uninsured 30 19 45 25

Improving the quality of care and reducing medical errors 15 16 12 18

Percent who reported that they want to hear candidates talk about…

Source: Kaiser Family Foundation. Kaiser Health Tracking Poll: Election 2008 – April 2008. Accessed at: http://www.kff.org/kaiserpolls/7772.cfm

57

Most Americans don’t understand how significantly chronic illnesses contributes to health care spending

and deaths in the U.S.

Percent of Americans who believe chronic disease is responsible for the following percent

of death and health spending in the U.S.

Percent answering: Death Spending

Less than 10% 3 6

10% but less than 20% 8 8








90% to 100% 3 4

Not sure 10 18

Only about 1 in 10 make an accurate estimate

Survey by the Partnership to Fight Chronic Disease: Conducted by APCO Insight, April 27-29, 2007 and based on telephone interviews with a national adult sample of 1,001.

58

Still, Americans recognize chronic diseases are a problem and say they want candidates to have a plan to

address them

62

29

0%

20%

40%

60%

80%

100%

Very important Somewhat important

How important is it for the 2008 Presidential candidates to have a plan to reduce chronic diseases?


59

Many Americans believe that access to care is a problem for people with chronic diseases…

8979787472

0

20

40

60

80

100

Access toPrimary Care

Specialist

ObtainingPrescriptionMedications

ReceivingHelp from

Family

Access toMedical

Specialist

GettingAdequateInsurance

Access and Coverage Problems


Percent who believe that the following factor is a problem:

60

… and that the U.S. should invest more in prevention

Four out of five Americans prefer health care dollars to be spent on preventive measures as opposed to treating diseases after the fact.

81 percent of adults interviewed believe the U.S. should prioritize our health care dollars to “invest in preventive measures”


61

Resources

PFCD Resources• PFCD Policy Platform:

http://www.fightchronicdisease.com/advocate/platform/index.cfm • PFCD “Unhealthy Truth” Presentation:

http://www.fightchronicdisease.com/resources/national.cfm • Chronic Care “Chartbook”:

http://www.fightchronicdisease.com/crisis/index.cfm

Partner Resources• Alliance for Aging Research Silver Book: http://www.silverbook.org/• American Cancer Society Cancer Facts & Figures 2007:

http://www.cancer.org/docroot/STT/content/stt_1x_cancer_facts__figures_2007.asp

• American Hospital Association Trendwatch Reports: http://www.aha.org/aha_app/trendwatch/archive.jsp

• Milken Institute “An Unhealthy America” Report: http://www.chronicdiseaseimpact.com/

• Partnership for Prevention

http://www.fightchronicdisease.com/advocate/platform/index.cfm

http://www.fightchronicdisease.com/resources/national.cfm

http://www.fightchronicdisease.com/crisis/index.cfm

http://www.silverbook.org/



http://www.aha.org/aha_app/trendwatch/archive.jsp

http://www.aha.org/aha_app/trendwatch/archive.jsp


more than 133 million americans -- 45 percent of the population

Health & Medicine

johns hopkins

human cost

chronic health

disease control

adult population

chronic conditions

disease control

chronic diseases