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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.

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Presentation on theme: "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."— Presentation transcript:

1 The Almanac of Chronic Disease 2008 Edition

2 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 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 4 Nearly half of Americans have one or more chronic diseases Total U.S. population 45% million Americans – have one or more Source: Wu S, Green A. Projection of Chronic Illness Prevalence and Cost Inflation. RAND Corporation, October 2000.

5 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 Percent of all Americans with chronic health conditions

6 6 Pulmonary conditions are among the most prevalent types of chronic health problems 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 Full report and methodology available at:

7 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 Degree of disability due to select chronic diseases plus depression Source: WHO World Health Survey, Moussavi, et al, (2007) Lancet DiabetesArthritisAnginaAsthmaDiabetesArthritisAnginaAsthma Degree of disability *Disability is the measure of difficulty completing important and ordinary life tasks and roles.

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

9 9 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 Source: American Diabetes Association. Total Prevalence of Diabetes and Pre-diabetes. Accessed at: https://www.diabetes.org/diabetes-statistics/prevalence.jsp

10 10 Diagnosis of many chronic diseases is on the rise in the U.S. Percent of U.S. adult population diagnosed with diabetes 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: Source: U.S. Centers for Disease Control & Prevention. Crude and Age-Adjusted Incidence of Diagnosed Diabetes per 1000 Population Aged Years, United States, 1980–2005. Accessed at:

11 11 Centers for Disease Control and Prevention, Prevalence of Diabetes and Impaired Fasting Glucose in Adults - United States, , MMWR, Vol. 52(35), p 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 12 Other cases of chronic disease are diagnosed, but not well-controlled Alliance for Health Reform Novartis/NIHCM Briefing. March 28, Original sources: NHANES Source: Presentation by David Cutler. Alliance for Health Reform Novartis/NIHCM Briefing. March 28, Original sources: NHANES Percent of U.S. adults with hypertension

13 13 And in other cases, chronic disease risk factors are starting to be better diagnosed and treated, although there is still room for improvement Alliance for Health Reform Novartis/NIHCM Briefing. March 28, Original sources: NHANES Source: Presentation by David Cutler. Alliance for Health Reform Novartis/NIHCM Briefing. March 28, Original sources: NHANES Percent of U.S. adults with high cholesterol Please note that percentage is slightly more than 100 due to rounding

14 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

15 15 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 Source: Centers for Disease Control and Prevention. Childhood Overweight. Accessed at:

16 16 The diagnosis of childhood chronic diseases has almost quadrupled over the past four decades 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 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, Available at: Accessed July 31,2006.

18 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 Source: Centers for Disease Control and Prevention. Prevalence of Regular Physical Activity Among Adults --- United States, 2001 and Accessed at: Age

19 19 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 Source: Centers for Disease Control and Prevention. Prevalence of Regular Physical Activity Among Adults --- United States, 2001 and Accessed at:

20 20 States in the South and New England have the highest rates of chronic diseases* 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 Full report and methodology available at:

21 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) Heart disease 2Cancer 3Cerebrovascular diseases (Stroke, hypertension) 4Unintentional injury Chronic lower respiratory diseases 5Chronic 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: Accessed April 6, Source: Centers for Disease Control and Prevention. Health, United States,

22 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 Range in Age and Most Do Not Live in Nursing Homes. November 8, 2000.

23 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: , 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, 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. 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 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 25 Three in four dollars spent on health care in the U.S. are for patients with one or more chronic conditions 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: Accessed April 6, Total U.S. health spending in 2006 = $2.1 trillion

26 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: Accessed on April 17, Share spent on patients with chronic diseases

27 27 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 Source: Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November 2007.

28 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 ~$211 billion Level of health spending among the noninstitutionalized 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: Also, Thorpe K, Florence CS, Joski P. Which Medical Conditions Account For The Rise In Health Care Spending?

29 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 Also, Centers for Disease Control and Prevention. U.S. Obesity Trends Available at:

30 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 trillion 79% 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 *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 Full report and methodology available at:

31 31 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* Source: DeVol, R, Bedroussian, A, et al. An Unhealthy America: The Economic Burden of Chronic Disease. The Milken Institute. October Full report and methodology available at: *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.

32 32 Presenteeism is responsible for the largest share of lost economic output associated with chronic health problems 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 *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 Full report and methodology available at:

33 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 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), Taken from: American Hospital Association. Trendwatch. Summer Accessed at: ArthritisHypertensionDepression/ Sadness/ Mental Illness AllergyMigraine/ Headache DiabetesAny Cancer AsthmaHeart Disease Respiratory Disorders

34 34 Depression and stress are the most common causes of absenteeism Number of days absent per affected individual per year due to 10 conditions, 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), Taken from: American Hospital Association. Trendwatch. Summer Accessed at: Depression/ Sadness/ Mental Illness Any Cancer Respiratory Disorders AsthmaMigraine/ Headache AllergyHeart Disease ArthritisDiabetesHypertension

35 35 … And mental illnesses, when comorbid* with other chronic diseases, significantly decrease work productivity 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): , December *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 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 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, 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 Also, Metlife Mature Market Institute and National Alliance for Caregiving, MetLife. Caregiving Cost Study: Productivity Losses to U.S. Business. July 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 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 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 Certain diseases, like heart disease and cancers, will be the most costly.

38 38 By the year 2023, the incidence of chronic disease is expected to rise dramatically Projected rise in cases of seven of the most common chronic diseases, * Source: DeVol, R, Bedroussian, A, et al. An Unhealthy America: The Economic Burden of Chronic Disease. The Milken Institute. October Full report available at: Note: Statistics only include data for top seven chronic diseaseswww.chronicdiseaseimpact.com *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.

39 39 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 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 (1):6-28; doi: /epirev/mxm007 By 2015 without major changes, researchers predict 75 percent of adults and 24 percent of children will be overweight or obese

40 40 If left unchecked, chronic diseases will cost our economy over $4.1 trillion by the year 2023… 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 Full report and methodology available at:

41 41 …And could cost the U.S. almost $6 trillion in lost economic output by 2050 $US Trillions *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. Projected lost economic output associated with seven of the most common chronic diseases* Source: DeVol, R, Bedroussian, A, et al. An Unhealthy America: The Economic Burden of Chronic Disease. The Milken Institute. October Full report and methodology available at:

42 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 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, Available at: Accessed April 17, 2007.

44 44 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. Target rate for use of service Source: Partnership for Prevention. Preventive Care: A National Profile on Use, Disparities, and Health Benefits. August Accessed at:

45 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: Only half receive appropriate preventive care

46 46 Many adults with serious chronic diseases feel they do not receive adequate care for their conditions Source: Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November Percent of U.S. adults with serious chronic conditions who believe they do NOT receive needed treatment Distribution by select group

47 47 Patients with chronic illness often see multiple health care providers, and this can make coordination of care complicated Source: Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November Number of different physicians seen by people with serious chronic conditions

48 48 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… Source: Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November 2007.

49 49 Non-white Americans often receive a different level of treatment for their chronic conditions Source: Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November 2007.

50 50 Physicians in the U.S. believe patients with chronic conditions often have problems accessing care Source: Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November Percent of physicians who believe access is difficult or very difficult for people with chronic conditions in the following areas:

51 51 Workplace health promotion programs have been shown to reduce health care costs, increase productivity and reduce absenteeism 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). Taken from: American Hospital Association. Trendwatch. Summer Accessed at:

52 52 By the year 2023, the U.S. can save over $1 trillion through investing in prevention, mostly in indirect costs* 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. Source: DeVol, R, Bedroussian, A, et al. An Unhealthy America: The Economic Burden of Chronic Disease. The Milken Institute. October Full report and methodology available at:

53 53 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 Source: DeVol, R, Bedroussian, A, et al. An Unhealthy America: The Economic Burden of Chronic Disease. The Milken Institute. October Full report and methodology available at:

54 54 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.

55 55 In 2008, health care is one of the top domestic issues that the public wants to hear presidential candidates talk about TotalRepublicanDemocratIndependent Iraq Economy Health Care Percent saying that they want candidates to talk about… Source: Kaiser Family Foundation. Kaiser Health Tracking Poll: Election 2008 – April Accessed at:

56 56 When it comes to health care, Americans say they want the candidates to talk about how to reduce costs TotalRepublicanDemocratIndependent Reducing the costs of health care and health insurance Expanding health insurance coverage for the uninsured Improving the quality of care and reducing medical errors Percent who reported that they want to hear candidates talk about… Source: Kaiser Family Foundation. Kaiser Health Tracking Poll: Election 2008 – April Accessed at:

57 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:DeathSpending Less than 10%36 10% but less than 20%88 20% but less than 30% % but less than 40% % but less than 50% % but less than 60% % but less than 70%79 70% but less than 80%87 80% but less than 90%43 90% to 100%34 Not sure1018 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 58 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? 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.

59 59 Many Americans believe that access to care is a problem for people with chronic diseases… Source: Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November Percent who believe that the following factor is a problem:

60 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” 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.

61 61 Resources PFCD Resources PFCD Policy Platform: PFCD “Unhealthy Truth” Presentation: Chronic Care “Chartbook”: Partner Resources Alliance for Aging Research Silver Book: American Cancer Society Cancer Facts & Figures 2007: p p American Hospital Association Trendwatch Reports: Milken Institute “An Unhealthy America” Report: Partnership for Prevention


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