Living Well with Chronic Illness A Call for Public Health Action (2012) / Chapter Skim
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, in the United States, chronic diseases currently account for 70 percent of all deaths (Kung et al., 2008; Wu and Green, 2000)
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Cardiovascular disease, many cancers, stroke, and chronic lung disease are the most common causes of death in America. But there are also other chronic diseases, such as arthritis, asthma, depression, and epilepsy, which have less substantial contributions to mortality but can severely diminish the health-related quality of life of the individuals who live with them, and effective disease prevention programs are not well developed.
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2. Which chronic diseases should be the focus of public health efforts to reduce disability and improve functioning and quality of life?
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but also in terms of the relative intensity of a strategy to meet the needs of the people who shoulder the greatest burden of nonfatal chronic illness. Fourth, a framework is used to describe the great variation in the causes, onset, clinical patterns, and outcomes of specific chronic diseases.
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. The very considerable costs that chronic diseases impose on society are due to many factors, including their high -- and, in many cases, apparently increasing -- prevalence; the aging of the population; advances in treatment that help sustain many individuals; their occurrence across the life course; and the highly disabling nature of many chronic illnesses, especially when inadequately treated.
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COMMUNITY-BASED INTERVENTIONS Evidence-based preventive interventions recommended for the general population are relevant to living well with chronic illnesses. Even when a particular health behavior is not directly related to a person's chronic illness (e.g., smoking and arthritis)
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, will be necessary to monitor the effectiveness of relevant health care and public health interventions to promote living well among patients with chronic illness. Longitudinal approaches to population health surveillance will also be necessary for determining the impact of interventions aimed at living well with chronic disease.
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In view of the many chronic diseases and the great heterogeneity of their clinical manifestations and outcomes in different individuals, communities, and populations, the committee does not recommend a specific set of diseases on which to focus for public health action. Instead, we chose nine exemplar diseases, health conditions, and impairments that have notable implications for the nation's health and economy; impact function and disability; often cut across chronic illnesses; complicate and/or increase risks for MCCs; and impact the community, families, and caregivers of those with chronic illness.
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The committee endorses CDC's emphasis on "winnable battles" and thinks that the exemplar approach will help identify new types of battles and population-based interventions in the management and control of chronic diseases. The nine exemplar diseases are arthritis, cancer survivorship, chronic pain, dementia, depression, type 2 diabetes, posttraumatic disabling conditions, schizophrenia, and vision and hearing loss.
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Also, there are many important intervention issues for living well with MCCs. Recommendation 2 Although research has attempted to characterize MCCs, the complexity of single chronic illnesses over time has not allowed for MCC taxono mies that will be easily applicable to public health control of chronic diseases.
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Which populations need to be the focus of interventions to reduce the consequences of chronic disease including the burden of dis ability, loss of productivity and functioning, health care costs, and reduced quality of life? Numerous studies have documented differences in the prevalence of chronic diseases and outcomes among racial and ethnic groups across the life cycle in the United States.
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All major chronic illnesses have the potential to impose an adverse impact on personal, family, and community economic status and the cost of medical care. At a time when the nation's ability to address widespread economic hardship is challenged, it is extremely important for public health programs to reach out to all with such illnesses.
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What consequences of chronic diseases are most important to the nation's health and economic well-being? The economic consequences of chronic illnesses for individuals, families, the health care system, and the nation are related to many factors, including the natural history and progression of the illness; secondary consequences of care; levels of treatment of adverse effects; the treatability of the primary illnesses; the economic, social, and medical care resources available to the patient; the chronic care models available; the direct cost of care; the presence of comorbidity; the impact on family function and economic productivity; and, to some extent, the impact of public health interventions on the illnesses.
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Therefore, the ACA can be leveraged as an existing law with important implications for living well with chronic illness at both the clinical and the community level. Recommendation 7 The committee recommends that CDC routinely examine and adjust relevant policies to ensure that its public health chronic disease man agement and control programs reflect the concepts and priorities em bodied in the current health and insurance reform legislation that are aimed at improving the lives of individuals living with chronic illness.
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Most of the literature related to population-based approaches to health improvement is not specifically focused on chronic disease. Although there is ample evidence of the effectiveness of widely disseminated wellness or lifestyle programs at community sites, there is inadequate evaluation of their impact on the health-related quality of life and health outcomes of individuals living with chronic illness.
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Recommendation 12 The committee recommends that federally supported efforts to improve living with chronic illness have as an explicit goal the reduction of health disparities across affected populations. • Barriers to obtaining complete assessments of community and pub lic health interventions for populations experiencing health dispari ties should be identified and addressed.
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evaluate existing (e.g., chronic care model, expanded chronic care model) , emerging, and/or new models of chronic disease care that promote cooperation among community-based organizations, the health care delivery system, em ployers and businesses, the media, and the academic community to improve living well with chronic illness.
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In the change process driving interventions to help patients with chronic illness live well and to improve the nation's health and economic well-being by reducing disability and improving quality of life and functioning, surveillance is the first step. This shift in focus from merely extending life to living well has the potential to facilitate decision making at the individual, health care system, and population levels, improving outcomes not only for patients and families but also for society.
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The sheer magnitude of this burden for society; the striking inequalities in living well among minorities, the elderly, and the disadvantaged; and the simple fact that numerous chronic illnesses are leading causes of death and disability are all emblematic of the considerable limitations of existing policies, programs, and systems of care and support for people living with chronic illness today. Government public health agencies have the ability to take action to help people live better with chronic illness.
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1990. A priority rating system for public health programs.
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