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Chronic Disease. A Public Health Perspective Ronald Fischbach, Ph.D. . Chronic Disease Overview . The most prevalent, costly, and preventable chronic diseases cardiovascular disease (primarily heart disease and stroke), cancer, and diabetes. Leading Causes of Death in the U.S., 2003.
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Chronic Disease A Public Health Perspective Ronald Fischbach, Ph.D.
Chronic Disease Overview • The most prevalent, costly, and preventable chronic diseases • cardiovascular disease (primarily heart disease and stroke), • cancer, and • diabetes
Costs of Chronic Disease, U.S. • In 2005, 133 million people, almost half of all Americans lived with at least one chronic condition • The medical care costs of people with chronic diseases account for more than 75% of the nation’s $2 trillion medical care costs. • $17,239 expenditure per household • Chronic diseases account for one-third of the years of potential life lost before age 65. • Hospitalizations for pregnancy-related complications occurring before delivery account for more than $1 billion annually. • The direct and indirect costs of diabetes is $174 billion a year.
Costs of Chronic Disease, U.S. (Continued) • Each year, arthritis results in estimated medical care costs of nearly $81 billion, and estimated total costs (medical care and lost productivity) of $128 billion. • The estimated direct and indirect costs associated with smoking exceed $193 billion annually. • In 2008, the cost of heart disease and stroke in the U.S. is projected to be $448 billion. • The estimated total costs of obesity was nearly $117 billion in 2000. • Cancer costs the nation an estimated $89 billion annually in direct medical costs. • Nearly $98.6 billion is spent on dental services each year.
Cost-Effectiveness of Prevention • Water fluoridation • Smoking cessation • Safer Choice Program (a school-based HIV, other STD, and pregnancy prevention program), • Preconception care • Arthritis Self-Help Course • Breast cancer
CDC's Chronic Disease Programs • CDC supports a variety of programs to improve the nation's health by preventing chronic diseases and their risk factors. • These programs provide national leadership • Sample CDS Program • Arthritis • Cancer Control • Diabetes • Healthy Aging • Healthy Youth • Heart Disease and Stroke • Nutrition, Physical Activity and Obesity • Safe Motherhood • Tobacco
Targeting Arthritis • Improving Quality of Life for More Than46 Million Americans • The Nation’s Most Common Cause of Disability • Arthritis comprises over 100 different diseases and conditions • Common symptoms
Why Is Arthritis a Public Health Problem? • An estimated 46 million U.S. adults (about 1 in 5) reported doctor-diagnosed arthritis • Nearly 19 million U.S. adults reported activity limitations because of arthritis • Work limitations attributable to arthritis affect about 1 in 20 adults • Arthritis results in 750,000 hospitalizations and 36 million outpatient visits • 128 billion dollars in annual costs • Arthritis is responsible for 9,500 deaths in the U.S. annually
What Can Be Done to Target Arthritis? • Self-management education programs • Chronic Disease Self-Management Program • Physical activity • Weight control and injury prevention • Early diagnosis and appropriate management
What Are CDC and Its Partners Doing About Arthritis? • CDC is committed to leading strategic public health efforts to promote well-being, prevent chronic disease, and achieve health equity. • For example, the National Arthritis Action Plan
What Activities Does CDC’s Arthritis Program Support? • The primary goal is to improve the quality of life for people affected by arthritis. • The program achieves this goal by supporting the following five key activities: • Building state programs • Reaching the Public • Improving the science base • Measuring the burden of arthritis • Making policy and systems changes
Future Directions for the CDC • Improve the quality of life for people affected by arthritis • Move state programs from building capacity to implementing programs on a wider scale • Identify model dissemination efforts • Develop innovative interventions that meet the needs of diverse populations • Work collaboratively with other chronic disease programs at federal and state levels
Chronic Disease Indicators • Ninety indicators that allows states and territories to uniformly define, collect, and report chronic disease data • Seven categories: • Physical activity and nutrition • Tobacco and alcohol use • Cancer • Cardiovascular disease • Diabetes • Overarching conditions • Other diseases and risk factors
Tobacco Use • The definition for each indicator includes a hyperlink to additional information and data resources. These include— • Behavioral Risk Factor Surveillance System (BRFSS) • Alcohol and Public Health • Youth Risk Behavioral Surveillance System (YRBSS) • State Tobacco Activities Tracking and Evaluation (STATE) System • National Program of Cancer Registries • State Cancer Profiles • CDC WONDER • Health-Related Quality of Life • United States Renal Data System (USRDS)* • Current Population Survey, American Community Survey • National Diabetes Surveillance System • National Oral Health Surveillance System
Tobacco Use: Behavioral Risk Factor Surveillance System (YRBSS)
Tobacco Use: Behavioral Risk Factor Surveillance System (YRBSS)- California
Tobacco Use: Behavioral Risk Factor Surveillance System (YRBSS)- California
Tobacco Use: Behavioral Risk Factor Surveillance System (YRBSS)- California
Tobacco Use: Behavioral Risk Factor Surveillance System (YRBSS)- California by Income
Tobacco Use: Behavioral Risk Factor Surveillance System (YRBSS)- California by Race
Tobacco Use: Behavioral Risk Factor Surveillance System (YRBSS)- California by Education
Tobacco Use: Behavioral Risk Factor Surveillance System (YRBSS)- California by Gender
What You Can Do • http://apps.nccd.cdc.gov/brfss/page.asp?cat=TU&yr=2007&state=CA#TU
What You Can Do (Continued) • Choose one of the other chronic diseases • Click on the choice • Explore the links and identify a possible public health intervention issue and target population
Review Questions (Developed by the Supercourse team) • What is the role of CDC in the prevention of non-communicable diseases? • Arthritis is a serious chronic disease, do you feel that it is receiving sufficient attention? • What more can be done to reduce smoking in the US?