Where We Focus Matters

At the turn of the last century the major health issues facing Americans were all related to infectious disease. Today the leading causes of death and disability are primarily chronic conditions that are all too familiar, many of which are preventable. Yet our healthcare conversations most often focus on cost, access, and quality. This sole focus on medical treatment and payment limits the potential of public health interventions to support good health, as well as the prevention of disease and disease complications. The total national health expenditures in 2015 were $3.2 trillion, with the per capita national health expenditures reaching $9,990. America’s health expenditures are expected to increase at an average rate of 5.6 percent per year through the year 2025 if current policies and conditions persist.

History shows that medical innovations and advances in public health have increased the life expectancy of our population by reducing early mortality resulting from infectious diseases such tuberculosis and diarrhea. As a result of this demographic and epidemiologic transition, increased life span is therefore correlated with chronic diseases and morbidities such as diabetes, heart disease and stroke, cancer, and dementia. In addition to advances in medicine, health behaviors are now more responsible for contributing to or preventing these novel chronic diseases.

• Chronic diseases accounted for seven of the top 10 causes of death in 2014
• 46% of all deaths in 2014 were caused by two chronic diseases—heart disease and cancer3
• Those who die of chronic disease before age 65 lose one-third years of potential life

Chronic disease negatively impacts population health beyond just deaths alone. The diseases tend to be long lasting, and are treatable; however, usually not curable. Disability and reduced quality of life are complications that are likely experienced by patients due to chronic disease. The burden of chronic disease is directly shared by Americans of all ages, and the associated economic impact is felt by taxpayers and employers alike.

• Over 117 million people in the United States—about half of all adults—have at least one chronic health condition3
• One in four U.S. adults have two or more chronic health conditions3
• At least 50% of U.S. adults do not meet recommended aerobic physical activity guidelines3
• Diabetes is the number one cause of kidney failure, lower-limb amputations, and new cases of blindness among adults, which can hinder daily tasks for the individual3
• More than one third of U.S. adults have at least one type of cardiovascular disease, some of which can be prevented through lifestyle interventions3

Most families are negatively impacted by chronic disease by some means: whether it be the personal diagnosis of a disease, grieving the death of a loved one, family members with long-term illness, disability, or reduced quality of life, or the financial and community burdens incurred through these diseases.

Our nation’s health must not be measured by the length of life, but by the quality of life of all Americans. Chronic diseases account for 86% of health care costs in the U.S. Therefore, the pressing issue of chronic disease and the preventive health measures in the country ought to be center stage when we talk about health.

The state of the nation’s health care system often emphasizes expensive advancements in the hopes of curing disease, however cost-effective preventive measures to avert such diseases should be a more primary focus. Traditional physician-patient visits are the typical point of care in our society. Although effective to treat acute illness, the visits tend to be infrequent and hurried. However, individuals spend considerably more time in their communities, whether it be at school, work, or recreation, where they are engaging in health risk or health promoting behaviors. Much of the time, the individual makes such decisions with minimal training, information, and health literacy. This is particularly true of the 28 million Americans who are uninsured and have limited access to health care services. Rather than emphasize the next best pill – let’s just ask ourselves how we can fit a walk into our busy day; add more fruits and vegetables to our diet; avoid tobacco; and do all these things with friends and family – because the social contact will also do us all good.

David P. Hoffman DPS CCE
Clinical Professor, UAlbany School of Public Health
Adjunct Asst. Professor, Albany Medical College

i Health expenditures. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/nchs/fastats/health-expenditures.htm Updated May 3, 2017. Accessed February 14, 2018.

ii NHE fact sheet. Centers for Medicare and Medicaid Services Web site. https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html Updated December 6, 2017. Accessed February 14, 2018.

iii Chronic disease overview. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/chronicdisease/overview/ Updated June 28, 2017. Accessed February 14, 2018.

iv Chronic disease prevention. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/program/performance/fy2000plan/2000vii.htm Updated June 30, 2011. Accessed March 5, 2018.

v Health insurance coverage in the United States: 2016. United States Census Bureau Web Site. https://www.census.gov/library/publications/2017/demo/p60-260.html Updated October 4, 2017. Accessed February 21, 2018.