Chronic diseases–such as heart disease, cancer, and diabetes–are the leading cause of death and disability in the United States. These diseases account for seven of every 10 deaths and affect the quality of life of 90 million Americans. Although chronic diseases are among the most common and costly health problems, they are also among the most preventable. Adopting healthy behaviors such as eating nutritious foods, being physically active and avoiding tobacco use can prevent or control the devastating effects of these diseases.
The combined costs of chronic diseases to our struggling health care system amount to just over a trillion dollars a year. By 2011 when the baby boomers start retirement, our ailing system will have even more stress. There is no doubt, the current Medicare system can not handle that financial strain.
Consider this, the least expensive 70% of Medicare / Medicaid recipients account for 10% of the money spent. With the lion’s share going for chronic conditions. The United States cannot effectively address escalating health care costs without addressing the problem of chronic diseases.
As mentioned earlier, 90 million Americans live with chronic illnesses accounting for 70% of all deaths. One risk factor associated with many cardiovascular diseases is smoking. The estimated costs associated with smoking exceed $75 billion annually.
A second risk factor, obesity is associated with arthritis and diabetes is further categorized into physical inactivity. And the direct medical cost associated with physical inactivity was over $76 billion in 2000.
Prevention is the easiest and cheapest way to combat chronic conditions. Let’s take for example smoking cessation campaigns. Studies have shown that stopping the use of tobacco is the most cost-effective method of preventing diseases among adults. It is estimated that for each smoker who successfully quits smoking he reduces the anticipated medical costs associated with heart attack and stroke by $47 in the first year and $853 over the next seven years.
One health insurance carrier’s annual cost of covering smoking cessation programs ranged from 89 cents to $4.92 per smoker. But the annual cost of treating smoking related illnesses ranged from $6 to $33 per smoker. For this reason smoking cessation programs have been called the gold standard in cost effective interventions.
Another chronic disease, diabetes accounts for nearly 21 million U.S. patients, some of whom don’t know they have the disease. More troublesome is pre-diabetes, a condition where blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes. There are 54 million people in the U.S. who have pre-diabetes. Those 54 million coupled with the 21 million known diabetics accounts for nearly 25% of the population.
The cost for those nearly 25% is estimated at $132 billion a year. The average annual health care cost for a person with diabetes is over $13,000 compared to $2500 for a person without diabetes. The good news is diabetes can be controlled and in some cases prevented thereby lowering the staggering costs associated with it.
Recent studies have found that lifestyle changes that include moderate weight loss and exercise can prevent the onset of diabetes among adults at high risk. For people already living with diabetes, early detection, improved delivery of care and better education can demonstrate tremendous benefits. Studies in the United States and abroad have found that better blood sugar control reduces the risk for eye disease, kidney disease, and nerve disease by 40% in people with type 1 or type 2 diabetes.
A final example of cost effectiveness is the effects of obesity on our society. In the past 30 years, the prevalence of persons being overweight and obese has increased sharply for both U.S. adults and children. In that 30 year time frame the number of obese adults aged 20-74 more than doubled to 33%. In children for the same time period the number of overweight kids nearly tripled to 14% in kids aged 2-5 years, it did triple to 19% for kids aged 6-11 and more than tripled for kids aged 12-19 to 17%.
This national problem puts our health care system at risk. Obese people are at increased risk for heart disease, hypertension, diabetes and some cancers. The estimated cost for obesity in the year 2000 was $117 billion annually.
A factor of obesity is the lack of physical activity. More than 50% of U.S. adults do not get enough exercise to receive health benefits, and 25% are not active at all in their leisure time.
Regular physical activity has many well known health benefits, reducing the risk for heart attack, colon cancer, diabetes, and high blood pressure and possibly the risk for stroke. Exercise also helps control weight; contributes to healthy bones, muscles, and joints; reduces falls among older adults; helps to relieve the pain of arthritis; reduces symptoms of anxiety and depression; and is associated with fewer hospitalizations, physician visits, and medications. Just 30 minutes of brisk walking most days can benefit adults of all ages.
As we are faced with growing pressure to trim Medicare and Medicaid and reign in payments, prevention should be examined, especially as baby boomers age. It is estimated that a man aged 50 that doesn’t smoke, is of normal weight and is physically active is at an 11% risk to develop coronary heart disease, diabetes or a stroke. While the same 50 year old that does smoke, is overweight and does not get any activity is at a 58% risk of developing heart disease, diabetes or a stroke. That is a five fold increase.
Identify those at risk early and instruct them on the risks is much cheaper than paying the hospital, physicians, and disability bills later.
This is especially important when you consider that as the baby boomers retire, the work force will be asked to support many more chronic diseases. Projected figures estimate that by 2011 many more people will be withdrawing from social security than contributing.
Programs must identify chronic diseases like heart disease, stroke, cancer, arthritis and diabetes. The common risk factors like tobacco use, physical inactivity, obesity and nutrition have to be targeted. Especially, we must target high risk patient populations in schools, work sites, and poor and minority populaces.
Presently prevention is given short shrift, actually we spend more on oil changes for our cars than we do for the prevention of chronic diseases. It is much more economical to get these programs up and running and see beneficial results than it is to pay and pay and pay for the medical and health consequences of chronic diseases.