The Almanac of
Chronic Disease
2008 Edition
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
2
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.
3
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.
4
Many Americans have more than one chronic
health problem
Percent of all Americans with chronic health conditions
30%
25%
23
20%
15%
12
10%
6
5%
4
4
4
5 plus
0%
1
2
3
Number of chronic conditions
Source: Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November 2007.
5
Pulmonary conditions are among the most
prevalent types of chronic health problems
Number (in millions) of Americans reporting specific chronic conditions*
2.4
Stroke
10.6
Cancers
13.7
Diabetes
19.1
Heart disease
30.3
Mental disorders
36.8
Hypertension
49.2
Pulmonary conditions
0
10
20
30
40
50
60
70
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.
6
Mental health conditions, such as depression,
dramatically increase disability* when paired with other
chronic health conditions
Degree of disability
Degree of disability due to select
chronic diseases
Degree of disability due to select chronic
diseases plus depression
25
25
20
20
15
15
10
20
19
17
10
6
5
23
7
7
3.5
5
0
0
Diabetes Arthritis
Angina
Asthma
Diabetes
Arthritis
Angina
Asthma
*Disability is the measure of difficulty completing important and ordinary life tasks and roles.
Source: WHO World Health Survey, Moussavi, et al, (2007) Lancet
7
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
100%
90
80%
72
68
1 or more chronic
conditions
2 or more chronic
conditions
60%
42
40
40%
20%
26
15
6
0%
0-19
20-44
45-64
65+
Ages
Source: Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November 2007.
8
Certain chronic diseases, such as diabetes, are more
prevalent among minority populations
Estimated age-adjusted total prevalence of diabetes in
people aged 20 years or older – United States, 2005
30%
22.6
25%
20%
13.3
15%
10%
9.5
8.7
5%
0%
White
African
American
Hispanic
Source: American Diabetes Association. Total Prevalence of Diabetes and Pre-diabetes. Accessed at:
https://www.diabetes.org/diabetes-statistics/prevalence.jsp
American Indian
and Alaskan
Native
9
Diagnosis of many chronic diseases is on the rise in the U.S.
Percent of U.S. adult population
diagnosed with diabetes
8%
7.4
Percent of U.S. adult population
diagnosed with asthma
8%
7%
7%
6%
6%
5%
5%
4%
4%
3.3
3%
3%
2%
2%
1%
1%
0%
0%
1980
2005
6.7
5.5
3
1970
1996
2003
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
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
10
Many cases of chronic diseases go undiagnosed
Total U.S. adults with diabetes = 18 million
One-third of
people with
diabetes, or nearly
6 million people,
don’t know they
have it
33% undiagnosed
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
Centers 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.
11
Other cases of chronic disease are diagnosed,
but not well-controlled
Percent of U.S. adults with hypertension
Unaware, 24%
Controlled, 31%
Aware, Not
Treated, 11%
Treated, Not
Controlled, 34%
Source: Presentation by David Cutler. Alliance for Health Reform Novartis/NIHCM Briefing. March 28, 2008.
Original sources: NHANES
12
And in other cases, chronic disease risk factors are starting to
be better diagnosed and treated, although there is still room
for improvement
Percent of U.S. adults with high cholesterol
1988-94
1999-2004
Controlled,
4%
Treated,
not
Controlled,
8%
Aware, not
Treated,
28%
Controlled,
25%
Unaware,
37%
Unaware,
61%
Treated,
not
Controlled,
16%
Please note that percentage is slightly more
than 100 due to rounding
Source: Presentation by David Cutler. Alliance for Health Reform Novartis/NIHCM Briefing. March 28, 2008.
Original sources: NHANES
Aware, not
Treated,
22%
13
Rates of obesity -- one of the key risk factors for a number
of chronic health problems -- have increased substantially
Percent of U.S. adults who are obese*
1985
No data
<10%
10%-14%
2005
No data
<10%
10%-14% 15%-19% 20%-24% 25%-29%
14
Source: Thorpe K, Florence, C, Howard, D, Joski, P. The Impact of Obesity in Rising Medical Spending. Health Affairs. 2004.
>30%
The share of children who are overweight has more than
doubled in the U.S. over the past two decades
Percent of children who are overweight
25%
18.8
20%
17.4
14
15%
10%
5
6.5
5
1980
2002
5%
0%
2-5yrs
6-11yrs
Source: Centers for Disease Control and Prevention. Childhood Overweight. Accessed at:
http://www.cdc.gov/nccdphp/dnpa/obesity/childhood/
12-19yrs
15
The diagnosis of childhood chronic diseases has almost quadrupled
over the past four decades
Percent of U.S. children diagnosed with a chronic illness
8%
7
7%
6%
5%
4%
3%
2%
1.8
1%
0%
1960
2004
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
16
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
One third = portion of who
will develop diabetes over
their lifetime, given
current trends in the share
who are overweight or
obese
*childhood overweight and obesity
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.
17
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
100%
80%
60%
43
49
50
54
25–34
35–44
45–64
60
40%
20%
0%
18–24
65+
Age
18
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
Minority Americans are less likely to get enough physical
activity, which may contribute to higher levels of chronic
disease among these groups
Percent of U.S. adults who are NOT getting recommended levels
of exercise
100%
80%
60%
64
60
50
53
48
55
58
40%
54
White
Black
Hispanic
Other
20%
0%
Women
Men
Race/Ethnicity/Gender
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
19
States in the South and New England have the highest
rates of chronic diseases*
Top Quartile
Second
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.
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.
20
Chronic diseases are the leading cause of death in the U.S.
Chronic disease accounts
for four of the top five
causes of death
Top 5 Causes of Death (1980, 2004)
Chronic
disease is
responsible
for seven out
of every 10
deaths each
year
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
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
21
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
Almost one in five (17
percent) family caregivers
provide 40 hours of care a
week or more
Family caregivers
provide the vast
majority (80 percent)
of all long-term care
services for those with
a chronic illness or
disability
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 Range
in Age and Most Do Not Live in Nursing Homes. November 8, 2000.
22
Caregiving can take a toll on caregivers' health
Family caregivers
experiencing
extreme stress have
been shown to have
weakened immune
systems, be more
prone to chronic
diseases themselves
and age
prematurely.
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.
This level of stress
can take as much as
10 years off a family
caregiver's life.
Noncaregivers
Children of
aging parents
Spousal
caregivers
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. 92:3051311, 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.
23
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.
24
Three in four dollars spent on health care in the U.S. are for
patients with one or more chronic conditions
Total U.S. health spending in 2006 = $2.1 trillion
25%
75%
Source: Centers for Disease Control and Prevention. Chronic Disease Overview page. Available at:
http://www.cdc.gov/nccdphp/overview.htm. Accessed April 6, 2007.
Health care costs
associated with
patients with one
or more chronic
diseases =
~$1.58 trillion
25
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
Share spent on patients with chronic diseases
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.
26
Not surprisingly, people with chronic conditions
are the heaviest users of health care services
Percent of services used by U.S. adults with chronic conditions
79
82
Physician Visits
Impatient Hospital Stays
Prescription Drugs
Home Health Care Visits
92
99
0%
20%
40%
60%
80%
100%
Source: Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November 2007.
27
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
$700
Level of health spending among the
noninstitutionalized U.S. population, 1987–2000
$600
$627.9
(in billions of nominal dollars)
= Increase
attributable
to rise in
prevalence
of treated
chronic
disease
$500
$400
~$211 billion
$313.5
$300
$200
$100
$0
'87
'88
'89
'90
'91
'92
'93
'94
'95
'96
'97
'98
'99
'00
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?
28
The doubling of obesity is responsible for about one-third
of the rise in health care costs since the mid-1980s
Percent of U.S. adults who are obese*
1985
No data
<10%
10%-14%
2005
No data
<10%
10%-14% 15%-19% 20%-24% 25%-29%
*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
29
>30%
Health care spending related to chronic diseases is
dwarfed by the indirect costs of these health problems
Total cost burden in 2003 for seven common chronic diseases*
Direct costs
represent about a
fifth of the total
cost burden of
chronic diseases
$277 billion
21%
$1.0 trillion
79%
Indirect costs
amount to fourfifths of the total
burden
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
*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.
30
Cancer and hypertension are among the most costly chronic
conditions, accounting for over $500 billion annually in
treatment expenditures and lost economic output
Treatment expenditures and lost economic output (in billions)
per chronic condition*
Stroke $22
Diabetes $27
$105
Pulmonary Conditions $45
Heart Disease
Mental Disorders
$65
$94
$105
$46
$171
Hypertension $33
Cancers
$280
$48
$0
$50
$271
$100 $150 $200 $250 $300 $350 $400
Treatment Expenditures
Lost Economic Output
*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.
31
Presenteeism is responsible for the largest share of lost
economic output associated with chronic health problems
Cost of chronic diseases by category, 2003
Total =
~$1 trillion
Lost Workdays
Individual,
$127 billion
Presenteesism
Caregiver,
$80 billion
Presenteesism
Individual,
Lost Workdays
Caregiver,
Presenteeism is
defined as lost
productivity that
occurs when
employees come
to work but
perform below
par due to any
kind of illness.
$11 billion
$828 billion
*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.
32
When it comes to presenteeism, arthritis, hypertension,
and depression are among the most costly conditions
Cost per Employee with Condition
Estimated average annual cost of presenteeism per employee with condition
$300
$252
$247
$246
$222
$189
$200
$159
$100
$76
$72
$71
$33
$0
Arthritis
Hypertension Depression/
Sadness/
Mental
Illness
Allergy
Migraine/
Headache
Diabetes
Any
Cancer
Asthma
Heart
Disease
Respiratory
Disorders
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.
33
Taken from: American Hospital Association. Trendwatch. Summer 2007. Accessed at: http://www.aha.org/aha/trendwatch/2007/twoct2007health.ppt
Depression and stress are the most common causes of
absenteeism
Number of days absent per affected individual per year due to
10 conditions, 1997-1999
Days per Year Absent
(Low, Average, High)
60
50
40
30
25.6
20
16.9
14.7
10
12.0
10.7
8.2
6.8
5.9
2.0
0
Depression/
Sadness/
Mental
Illness
Any
Cancer
Respiratory
Disorders
Asthma
Migraine/
Headache
Allergy
Heart
Disease
Arthritis
0.9
Diabetes Hypertension
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.
34
Taken from: American Hospital Association. Trendwatch. Summer 2007. Accessed at: http://www.aha.org/aha/trendwatch/2007/twoct2007health.ppt
… And mental illnesses, when comorbid* with other
chronic diseases, significantly decrease work productivity
Number of 30-day role impairment days associated with pure and
comorbid* chronic illnesses
Average Number of Impaired Days per
Month
4
(Role impairment = sickness absence days plus work cut-back days)
3
2
1
0
Hypertension
Arthritis
Asthma
Ulcers
Chronic Disease
Chronic Disease and Mental Illness
*Cormorbidity is the condition of having two or more diseases at the same time.
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.
35
Caregiving costs workers and employers
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.
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.
36
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.
37
By the year 2023, the incidence of chronic disease is
expected to rise dramatically
100% Projected rise in cases of seven of the most common
chronic diseases, 2003-2023*
80%
62
54
60%
53
41
39
40%
31
29
20%
e
St
ro
k
ns
iti
o
on
d
C
ar
y
Pu
lm
on
yp
e
H
tD
ea
r
rt
e
is
e
ns
i
as
on
e
et
es
ia
b
D
H
M
en
ta
l
D
C
is
o
an
c
rd
e
er
s
rs
0%
*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 available at: www.chronicdiseaseimpact.com. Note: Statistics only include data for top seven chronic
diseases
38
The rate of obesity is also expected to increase, and
contribute to rising rates of chronic diseases
By 2015, it is predicted that 41 percent of Americans will be obese
100%
80%
By 2015 without major changes, researchers predict 75
percent of adults and 24 percent of children will be
overweight or obese
60%
41
40%
20%
32
13
0%
1960
2004
2015
Year
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
39
If left unchecked, chronic diseases will cost our
economy over $4.1 trillion by the year 2023…
Lost Economic Output
Treatment Expenditures
20
03
20
06
20
09
20
12
20
15
20
18
20
21
$4,500
$4,000
$3,500
$3,000
$2,500
$2,000
$1,500
$1,000
$500
$0
Projected costs associated with seven of the most
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.
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.
40
…And could cost the U.S. almost $6 trillion in
lost economic output by 2050
6
Projected lost economic output associated with seven
of the most common chronic diseases*
$US Trillions
5
4
3
2
1
20
05
20
10
20
15
20
20
20
25
20
30
20
35
20
40
20
45
20
50
0
*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.
41
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.
42
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…
80% of type
2 diabetes
40% of cancer
80% of
heart
disease
and
stroke
…could be prevented if only Americans were to do three things:
 Stop smoking
 Start eating healthy
 Get in shape
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.
43
Increasing the use of common preventive care services could
save 100,000 lives each year in the United States alone
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.
100%
90
90
90%
90
90
90
Target rate for
use of service
80%
67
70%
60%
50
50
50%
37
40%
28
30%
20%
10%
0%
Daily dose of aspirin
Smokers who are
advised by health
professional to quit
and offered
medication or other
assistance
Current rates
Adults age 50+ who are
up to date with any
recommended
screening for
colorectal cancer
Flu immunization for
people 65+
Breast cancer
screening for women
age 40 and older
Rates needed to save 100,000 lives annually
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
44
There is also substantial room for improvement in
treating chronically ill patients to prevent further
complications
Only half
receive
appropriate
preventive
care
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.
45
Many adults with serious chronic diseases feel they do not
receive adequate care for their conditions
Percent of U.S. adults with serious chronic conditions
who believe they do NOT receive needed treatment
80%
71
70%
59
60%
50%
57
46
46
Insured
Total
43
40%
30%
20%
10%
0%
White
Non-White
Hispanic
Uninsured
Distribution by select group
Source: Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November 2007.
46
Patients with chronic illness often see multiple health
care providers, and this can make coordination of care
complicated
Number of different physicians seen by people with
serious chronic conditions
6+ Physicians
11%
5 Physicians
6%
No Doctors
3%
1 Physician
16%
4 Physicians
15%
2 Physicians
26%
3 Physicians
23%
Source: Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November 2007.
47
Conflicting or confusing information can be a serious
problem for Americans with chronic diseases
Percent of U.S. adults with chronic health problems reporting that they…
Had duplicate tests or
procedures
18
Received conflicting
information from providers
17
Received information about
drug interactions upon
filling prescription
16
Received different
diagnoses form different
providers
0%
14
5%
10%
15%
Source: Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November 2007.
20%
48
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:
35%
32
30%
25
25%
20%
25
21
18
15
15%
Non-White
White
10%
5%
0%
Received
Received
Conflicting Advice Duplicate Tests
Given Conflicting
Prescriptions
Source: Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November 2007.
49
Physicians in the U.S. believe patients with chronic
conditions often have problems accessing care
Percent of physicians who believe access is difficult or very difficult for
people with chronic conditions in the following areas:
Primary Care Doctors
Other Health Care Professionals
Medical Specialists
53
55
56
Prescription Drugs
65
Patient Special Education or Training
75
Respite Care for Family
78
Adequate Health Insurance
80
Mental Health Care
84
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Source: Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November 2007.
50
Workplace health promotion programs have been shown
to reduce health care costs, increase productivity and
reduce absenteeism
Average percent change in employers’ costs resulting from workplace
health promotion and wellness programs
Health
costs
-25
Workers’ comp./
Absenteeism disability management
claims costs
Average Change
-26
-27
-27%
-28
-28%
-29
-30
-30%
-31
Source: Chapman, L. (2003). Meta-evaluation of Worksite Health Promotion Economic Return Studies. Art of Health Promotion Newsletter, 6(6).
51
Taken from: American Hospital Association. Trendwatch. Summer 2007. Accessed at: http://www.aha.org/aha/trendwatch/2007/twoct2007health.ppt
By the year 2023, the U.S. can save over $1 trillion
through investing in prevention, mostly in indirect costs*
$1,200
$1,000
Lost economic output (indirect)
Treatment expenditures (direct)
$800
$600
$400
$200
20
04
20
06
20
08
20
10
20
12
20
14
20
16
20
18
20
20
20
22
$0
*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.
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.
52
Investing in prevention will save the U.S. billions of
dollars in direct and indirect health costs
Costs of chronic disease (in billions) in 2023 due to treatment
expenditures and lost economic output
Stroke $74 $24
Pulmonary Conditions
$310
Diabetes
$73
$340
Heart Disease
$90
$292
Mental Disorders
$213
$587
Hypertension
$116
$731
Cancers
$196
$696
$0
$410
$400
$800
$1200
Billions
Alternate future
Costs that could be avoided through prevention
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.
53
Chapter Five: Understanding of the
Problem and Support for Change
Introduction:
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.
54
In 2008, health care is one of the top domestic issues that
the public wants to hear presidential candidates talk about
Percent saying that they want candidates to talk about…
Total
Republican Democrat
Independent
Iraq
49
49
53
47
Economy
42
33
50
40
Health Care
23
19
29
18
Source: Kaiser Family Foundation. Kaiser Health Tracking Poll: Election 2008 – April 2008. Accessed at:
http://www.kff.org/kaiserpolls/7772.cfm
55
When it comes to health care, Americans say they want
the candidates to talk about how to reduce costs
Percent who reported that they want to hear candidates talk about…
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
Source: Kaiser Family Foundation. Kaiser Health Tracking Poll: Election 2008 – April 2008. Accessed at:
http://www.kff.org/kaiserpolls/7772.cfm
56
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
20% but less than 30%
14
12
30% but less than 40%
15
10
40% but less than 50%
15
12
50% but less than 60%
12
11
60% but less than 70%
7
9
70% but less than 80%
8
7
80% but less than 90%
4
3
90% to 100%
3
4
10
18
Not sure
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.
57
Still, Americans recognize chronic diseases are a problem
and say they want candidates to have a plan to address them
How important is it for the 2008 Presidential candidates
to have a plan to reduce chronic diseases?
100%
80%
62
60%
40%
29
20%
0%
Very important
Somewhat important
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
Many Americans believe that access to care is a problem
for people with chronic diseases…
Percent who believe that the following factor is a problem:
100
80
89
72
74
78
79
Receiving
Help from
Family
Access to
Medical
Specialist
60
40
20
0
Access to
Obtaining
Primary Care Prescription
Specialist Medications
Getting
Adequate
Insurance
Access and Coverage Problems
Source: Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November 2007.
59
… 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”
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.
60
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.as
p
• 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
61