Health is shaped by many factors, including genetics, access to quality medical care, social circumstances, health literacy, environment, and behavioral choices. There is clear evidence that chronic diseases account for much of the disability and mortality in the United States and across the world, and the direct and indirect costs associated with them, in large part due to preventable risk factors. Risk factors such as obesity, lack of physical activity, and exposure to tobacco smoke greatly increase the risk of developing the most serious chronic diseases. Current health care spending practices in the United States are concentrated on treating chronic diseases, while only a very small portion of expenditures are focused on preventing these diseases. In addition, much of the discussions on health care reform are focused on who pays for health care. However, focusing on prevention and the reduction of risk factors for chronic disease is essential to reducing the burden of disease, improving quality of life, and decreasing health care costs.
Click on the publications below to learn more about prevention and best practices to reduce the burden of disease.
Prevention Publications
Health-Care Cost Projections for Diabetes and other Chronic Diseases: The Current Context and Potential Enhancements
In the United States, chronic diseases account for more than 75 percent of the approximately $2 trillion Americans spend each year on health care. Noted experts, including the director of the Congressional Budget Office (CBO) and the Comptroller General of the United States, have stated that the greatest threat to the nation's economic strength is the coming explosion in governmental health care spending in the Medicare and Medicaid programs. Yet the majority of Medicare spending is for treatment of individuals with one or more chronic diseases. Any efforts to improve these programs and slow growth in health care spending will be unsuccessful if they fail to address the burden of chronic disease.
"Health-Care Cost Projections for Diabetes and other Chronic Diseases" outlines the current process the U.S. government uses to estimate costs of health policy proposals and explores policy enhancements to improve the budgetary information available to policymakers for chronic diseases.
CBO has developed a sophisticated microsimulation system to make long-term budgetary projections to better inform policymakers about the expected increase in Social Security, Medicare, and Medicaid programs. CBO predicts dramatic increases in health care costs in the future, with total public and private spending increasing from 15 percent of GDP today to 49 percent of GDP in 2082. CBO also projects the impact of large-scale implementation of policy changes that may have been tested through clinical trials, pilot programs, demonstration projects, or otherwise implemented on a different scale than the policy change would involve.
The authors of Health-Care Cost Projections for Diabetes and other Chronic Diseases suggest incorporating the latest evidence from clinical medicine – including health status, health trends, and epidemiology of certain chronic diseases – into the assumptions upon which cost projections are based. Additionally, the authors recommend extending the current 10-year CBO scoring window in selected instances, such as in the case of chronic disease, to capture the full benefit and cost of programs that improve health.
O'Grady, M. and Capretta, J. (2009). Health-Care Cost Projections for Diabetes and other Chronic Diseases: The Current Context and Potential Enhancements. White paper.
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A Closer Look at the Economic Argument for Disease Prevention
Current health care spending in the United States is concentrated on treating chronic diseases, while only a very small portion of expenditures are focused on preventing these diseases. Of the more than $2 trillion spent on health care in the United States each year, only 2 to 3 percent is spent on prevention. However, focusing on prevention and the reduction of risk factors for chronic disease is essential to reducing the burden of disease, improving quality of life, and decreasing health care costs. Still there is debate as to whether prevention programming saves money. In the commentary A Closer Look at the Economic Argument for Disease Prevention, published in the February 4, 2009, Journal of the American Medical Association, the author argues that the context used to frame our discussion regarding the value of prevention is critical. Depending upon the program or interventions used, an investment in prevention can lead to better health outcomes for an individual or population and/or cost-savings or cost-effective results overall.
Economically investing in prevention has been difficult because systems, individual behaviors, and health outcomes take time to change, and the delayed effects ward off continued investment in prevention programs. A Closer Look presents both the economic concerns and benefits of disease prevention and highlights that we need to consider all options for promoting health and wellness through prevention in order to make the most of every health care dollar we spend.
Steven H. Woolf. A Closer Look at the Economic Argument for Disease Prevention. JAMA. 2009;301(5):536-538.
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Read commentary on JAMA article from the Robert Wood Johnson Foundation
Decline in Smoking Prevalence – New York City, 2002-2006
Cigarette smoking is the single-most preventable cause of death and disease in the United States, contributing to more than 400,000 American deaths each year. In 2002, the New York City Department of Health and Mental Hygiene launched a five-point anti-smoking campaign, including increased tobacco taxes, smoke-free workplace regulations, public and health care education, smoking cessation services, and rigorous program evaluation. Between 2002 and 2004, these activities led to a decrease in the prevalence of smoking among New York City adults from 21.5 percent to 18.4 percent, but the adult smoking prevalence remained unchanged in 2005. In 2006, to address this continuing public health concern, the Department of Health and Mental Hygiene launched a televised anti-tobacco public education campaign in both Spanish and English. The New York City campaign was timed to coincide with an anti-tobacco media campaign conducted by New York State, which helped increase New York City residents' exposure to messages about the health effects of smoking. The statewide campaign also emphasized the impact of secondhand smoke on the health of children.
The results of the 2002 and 2006 tobacco control efforts contributed to an overall 19 percent reduction in smoking among New York City adults – totaling 240,000 fewer adult smokers. Even more dramatic were the reductions in smoking among particular demographic groups, such as young adults (34.9 percent), Asians/Pacific islanders (30.1 percent), women (22.7 percent) and Hispanics/Latinos (20.5 percent). These results emphasize the value of a comprehensive, integrated approach to tobacco control, and offer best practices for communities to consider as they work to reduce tobacco use among their populations.
Ellis JA, Perl SB, Frieden TR, Huynh M, Ramaswamy C, Gupta LS, Kerker BD. Decline in smoking prevalence – New York City, 2002-2006. Morbidity and Mortality Weekly Report 2007; 56(24):604-8.
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An Unhealthy America: The Economic Burden of Chronic Disease – Charting a New Course to Save Lives and Increase Productivity and Economic Growth
Chronic diseases – such as type 2 diabetes, heart disease, and certain types of cancer – represent a rapidly growing segment of the disease burden in the United States. Chronic disease is taking a significant economic toll on the nation, in addition to the personal toll on individuals and families. In this report, the Milken Institute estimates the current and future treatment costs and lost productivity related to seven chronic diseases, each of which has been linked to preventable risk factors (e.g., smoking, sedentary living, etc.). The authors note that these seven diseases currently cost the United States $1.3 trillion annually in lost productivity and treatment, and they estimate that these costs will rise to $4.2 trillion by 2023. With even modest changes in the way America approaches health care, such as focusing on prevention, reducing risk factors, and treating disease in earlier stages, these costs could be reduced by 27 percent.
The Milken Institute. An Unhealthy America: The Economic Burden of Chronic Disease – Charting a New Course to Save Lives and Increase Productivity and Economic Growth. 2007.
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