Chronic Diseases Are Main US Public Health Concern

Larry Hand

July 02, 2014

Noncommunicable diseases are the main cause of illness and disability in the United States and are responsible for the bulk of healthcare spending, according to the Centers for Disease Control and Prevention (CDC). Most of these chronic conditions result from preventable risk factors, the authors write in an article published online July 2 in the Lancet.

Ursula E. Bauer, PhD, from the CDC, Atlanta, Georgia, and colleagues explain that meeting the burden of chronic diseases will require the implementation of 4 strategies involving public–private partnerships and all healthcare stakeholders. The article is the first in a series of 5 pieces being published in the journal about the health of Americans.

About half (50.9%) of the adults in the United States have at least 1 chronic condition, and 26% have 2 or more chronic conditions. A few risk factors fuel the burden of chronic disease, including tobacco use, poor diet, physical inactivity, excessive alcohol consumption, high blood pressure, and high cholesterol.

Chronic diseases accounted for 10 of the 15 leading causes of death in the United States during 2011, including heart disease, cancer, chronic lower respiratory diseases, Alzheimer's disease, diabetes, and kidney diseases, according to the CDC.

The CDC uses 4 strategies, or "domains," to try meet the chronic diseases burden:

  1. epidemiology and surveillance to monitor trends and inform programs,

  2. environmental approaches that promote health and support healthy behaviors,

  3. health system interventions to improve the effective use of clinical and other preventive services, and

  4. community resources linked to clinical services that sustain improved management of chronic conditions.

Epidemiology and surveillance data "document successes, identify gaps and disparities, and provide critical information to advance policy," the authors write.

The second domain shows how community efforts can promote population health and reduce chronic disease burden. Examples of this include antismoking policies and programs and initiatives to improve street connectivity and encourage walking and bicycling.

Healthcare system interventions can include such programs as the National Breast and Cervical Cancer Early Detection program and healthcare reform such as the Affordable Care Act.

The fourth domain involves helping people manage their chronic conditions and improve their quality of life, including programs such as the National Diabetes Prevention Program.

"The four domains capture strategies that simultaneously address many conditions and risk factors by improvements to the common factors that underlie so many poor health behaviours — tobacco use, poor diet, lack of physical activity — and by strengthening opportunities and supports for engagement in healthy behaviours," the authors write.

They conclude, "We need to increase our attentiveness to data, be even more vigilant with surveillance systems, and use comprehensive approaches that can be scaled up to reach the entire population, with a focus on people with the poorest health status. To reduce the chronic disease burden in the USA will require work across several sectors, including health care, to ensure that community environments promote and sustain behaviours that contribute most to health."

Lancet. Published online July 2, 2014. Abstract


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