Chronic Illness and Disease Prevention

Chronic Illness and Disease Prevention

George A. Mensah, M.D.

Acting Director, National Center for Chronic Disease

Prevention and Health Promotion

Centers for Disease Control and Prevention

1900-1999•Vaccination•Motor-vehicle safety•Safer workplaces•Control of infectious

diseases

Adapted from MMWR 1999;48(50):1141

1900-1999•Decline in deaths from

heart disease & stroke

•Safer and healthier foods

•Healthier mothers and babies


1900-1999•Family planning

•Fluoridation of drinking water

•Recognition of tobacco use as a health hazard


Achievements in Public Health, 20th Century

Age-adjusted to the 2000 US population.; Sources: NHLBI, Morbidity and Mortality Chart Book 2000 CDC, Health, United States 2001

0

100

200

300

400

500

600

700

800

900

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000

Year

Dea

ths

per

100

000

Total cardiovascular diseases

Diseases of the heart

Coronary heart disease

Stroke

Measuring State Successes:Improvements from 1990 to 2004

ME Infectious Disease 62%

SOURCE: America’s Health: State Health Rankings. United Health Foundation 2004



RI Smoking 35%




VT Infant Mortality 53%

RI Smoking 35%





PA Infant Mortality 30%

RI Smoking 35%






IA Infant Mortality 39%

RI Smoking 35%







LA Children in Poverty 34%

RI Smoking 35%






LA Children in Poverty 34%

AK Infectious Disease 83%


RI Smoking 35%


Maine Infectious Disease 62%

Rhode Island Smoking 35%

Vermont Infant Mortality 53%

Pennsylvania Infant Mortality 30%

Iowa Infant Mortality 39%

Louisiana Children in Poverty 34%

Alaska Infectious Disease 83%



Definition of Public Health

Public Health:Population-based

Health

Health Care vs. Public Health

“Health care is vital to all of us

some of the time, but public health is vital to

all of us all of the time.”

Public Health:Population-based

Health

C. Everett Koop

Health Promotion and Chronic Disease Prevention

Public Health; New York City, 1895

Department of Health, City of New York

We Face an Epidemic ofUnparalleled Proportions

• More than 1.7 million Americans die of a chronic disease each year

• One-third of the years of potential life lost before age 65 is due to chronic disease

• Four chronic diseases—heart disease, cancer, stroke, and diabetes—cause almost two-thirds of all deaths each year

We Face an Epidemic ofUnparalleled Proportions

• Approximately 33% of all U.S. deaths (about 700,000 deaths each year) can be attributed to these three health-damaging behaviors …

– tobacco use

– lack of physical activity

– poor eating habits Sources:

Deaths: Preliminary Data for 2002. NVSR Volume 52, Number 13. 48pp. (PHS) 2004-1120. Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2003). McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993; 270:2207-12.

Disability and Diminished Quality of Life Chronic, disabling conditions cause major limitations in activity for 1 of every 10 Americans (30 million people)

Arthritis • number one cause of disability• affects nearly 1 of every 3 adults in the US

Stroke • left 1 million Americans with disabilities

Diabetes • leading cause of kidney failure in adults• more than 60% leg and foot amputations are

among people with diabetes

Health Care Spending is on the RiseOur nation spends more on health care

than any other country in the world

Chronic diseases account for 75% of the $1.4 trillionwe spend on health care

$245 billionan average of $1,066 per person

1980

$1.4 trillionan average of $5,039 per person

2001

SOURCE: Heffler et al., Health Affairs., Health Spending Projections For 2001-2011: The Latest Outlook, March/April 2002.

$2.8 trillionan average of $9,216 per person

2011

Life Expectancy vs. Health Care Spending

Per Capita Health Care Spending in International Dollars

Lif

e E

xpec

tan

cy

30

40

50

60

70

80

90

0 500 1000 2000 3000 4000 50001500 2500 3500 4500

Sierra Leone

United States

Japan

Cuba

An Aging PopulationPercentage of U.S. Population over Age 65

0

5

10

15

20

25

1930 1950 1970 1990 2010 2030 2050

Year

Perc

en

t

Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population. Washington, DC: Watson Wyatt Worldwide, 1996

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

>80

75-7

9

70-7

4

60-6

4

55-5

9

50-5

4

45-4

9

40-4

4

35-3

9

30-3

4

25-2

9

20-2

4

15-1

9

10-1

4

0-4 5-9

65-6

9

Women

Men

Dollars

Age in Years

Estimated Per Capita Health Expenditures,by Age and Sex, 1995

Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population. Washington, DC: Watson Wyatt Worldwide, 1996

Medicaid ExpendituresState FY 2003

actualFY 2004estimate

% of total expenditures

Alaska 786 638 8.4

Iowa 2,436 2,124 15.6

Louisiana 4,450 4,772 24.5

Maine 1,712 1,772 29.0

Pennsylvania 13,623 14,375 29.5

Rhode Island 1,450 1,568 25.5

Vermont 691 795 27.5

Source: National Association of State Budget Officers, 2003 State Expenditures Report

Predicted Likelihood of Developing Coronary Heart Disease, Stroke, or Diabetes by Age 65

SmokerOverweight

Inactive Ratio

11% 58% 5.5

Source: Jones et al. Arch Intern Med 2002;162:2565–71

Non SmokerNormal Weight

Active

Men, Aged 50

Disability Index,* by Age and Health Risk†

University of Pennsylvania Alumni

63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 780.00

0.05

0.10

0.15

0.20

0.25

0.30

Dis

abili

ty Index

Age

* Progression of disability was postponed by approximately 7 years in low risk vs. high risk.† Risk based on body mass index, smoking, exercise; 0-3 point scale for each; low = 0–2

points, moderate = 3–4 points, high = 5–9 points.Note: A disability index of 0.1 = minimal disability.Source: Vita et al. N Engl J Med 1998;338(15):1035–41

High risk

Moderate risk

Low risk

Adult per Capita Cigarette Consumption and Major Environmental and Policy Changes in the

US 1900-1990

0

1

2

3

4

5

Great Depression

End ofWW II

First Medical reportslinking smoking and cancer

Thousands per year

US Surgeon General’s first

report

Broadcast advertising ban

Federal cigarette

tax doubles

Nonsmoker’s rights movement beginsFairness Doctrine messages on radio and television

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990

Year

Admissions for Acute Myocardial Infarction During 6-Month Periods June–November Before, During,

and After the Smoke-free Ordinance

Source: Sargent RP et al. BMJ 2004.

0

10

20

30

40

50

60

1998 1999 2000 2001 2002 2003

Year

Ad

mis

sio

ns

Helena

Outside Helena

New York Centers of Excellence

• 39% reduction in lower-extremity amputation

• 35% reduction in hospitalization for persons with diabetes

Promising Practices in Chronic Disease Prevention and Control, DHHS, 2003

Return on Investment in Worksite Health Promotion

• Citibank: in 1994, return on investment = $4.56-$4.70 per dollar invested in the program (Ozminkowski et al. AJHP Jan/Feb 1999)

• Johnson & Johnson: reduction of medical care costs of $224.66 per employee per year (Ozminkowski RJ et al. Environ Med 2002; 44:21-29)

• 13 health promotion programs reported cost benefits ratios suggest improved financial outcomes (Aldana AJHP May/June 2001)

Cigarette Use:

40% middle school students

18% high school students

The addition

of walking

trails can

promote

physical

activity,

especially

among

women.

Death Rate and Average Annual Percentage Change

3 Leading Cancers in Men, 1990 and 2001*

† Per 100,000 1970 standard population

Lung 90.6 75.1 -1.8

Prostate 38.6 29.1 -2.9

Colorectal 30.8 24.2 -2.1

Age-Adjusted Rate† Average Annual% Change1990 2001

Adapted from MMWR-SS 2004;53:SS-3*

Death Rate and Average Annual Percentage Change

3 Leading Cancers in Women, 1990 and 2001*

† Per 100,000 1970 standard population

Lung 36.8 40.9 + 0.9

Breast 33.1 25.9 -2.3

Colorectal 20.6 17.0 -1.7

Age-Adjusted Rate† Average Annual% Change1990 2001

Adapted from MMWR-SS 2004;53:SS-3*

Implement programs that focus on eliminating health disparities.

REACH 2010:

Charleston And Georgetown

Diabetes Coalition

Arlene Case-The Lesson

Ensure access to quality health services.

Enact policies that promote healthy environments.

Promote wellness programs in schools, work sites, and in faith- and community-based settings.

Summary•Remarkable achievements in health over last century

•Chronic diseases and risk factors now pose major challenges – a cause for ALARM!

•Power of prevention, and role of policy & environmental change – reasons for HOPE!

•We need to act NOW!

Partnerships

Documents

Chronic Illness and Disease Prevention