2009 almanac of chronic disease

2009

!"#!$!%&'(&%)*'$+%&,+-.!-.The Impact of Chronic Disease on U.S. Health and Prosperity

A Collection of Statistics and Commentary

4

table of contents

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12009 ALMANAC OF CHRONIC DISEASE

acknowledgements

The Partnership to Fight Chronic Disease (PFCD) would like to thank the following PFCD partners for sponsoring the 2009 Almanac of Chronic Disease:

! " ! " !

American Academy of Nursing

Canyon Ranch Institute

DMAA: The Care Continuum Alliance

National Association of Chronic Disease Directors (NACDD)

National Association of Public Hospitals and Health Systems (NAPH)

Pharmaceutical Research and Manufacturers of America (PhRMA)

U.S. Chamber of Commerce

YMCA of the USA

! " ! " !

2

As 17th Surgeon General of the United States, I made every decision

based on the knowledge that the strength of our great nation is in the

good health of its people. Today, as our country faces tremendous

economic challenges, we must remember that improving the health and

well-being of the American people is always a good investment.

Throughout my career as a medic, registered nurse, physician, university

professor, and as CEO of a health system, I learned that helping

people to prevent disease and live healthier lives boosts individual and

community productivity and makes health care more affordable. Today,

millions of people are applying these same seemingly simple principles to

the way they lead their families, communities and businesses – and even

the way they govern.

This is good news because these same principles must also be a part

of meaningful health reform. The reality is that our current health care

system is not truly serving our health needs. We have focused on treating

illness rather than promoting prevention and wellness. The negative

consequences of this sick-care system are taking a toll on our health, our

economic stability and the futures of our children and grandchildren.

Chronic diseases, such as asthma, cancer, diabetes and heart disease,

affect approximately 133 million Americans. These often-preventable

health problems ultimately lead to 70 percent of the deaths in our country

each year. Future generations are also being impacted in ways that as a

young physician in training 30 years ago, I could never have imagined.

The percentage of children who are overweight or obese has more than

doubled in the past 20 years, leading to historic rates of “adult” diseases

being diagnosed in children. For the first time ever, children may have a

shorter lifespan than their parents.

The good news is that we can stop and even reverse this trend. This

work is not easy, and it requires dedication and investment. This Almanac

can be used as a resource by everyone who is seeking real, evidence-

based solutions to the crisis of chronic disease.

Since launching the Partnership to Fight Chronic Disease in 2007, our

hundreds of national and state-based partners have shown that we can

build consensus around common principles, set aside small differences

and together transform our culture from one that focuses only on

treating illnesses after they occur to one that embraces and

incentivizes prevention.

foreword


As individuals, we can make small changes in our lives, like reducing

intake of fats and sugars, eliminating smoking and including physical

activity in our daily lives.

As leaders in businesses and communities, we can support the health of

our workforces and our neighbors through workplace wellness programs

and community-based prevention initiatives.

As a nation, we can embrace prevention and earlier diagnosis of disease

through screenings and improve management of chronic disease to avoid

costly health complications.

In the following Almanac chapters, the scientific evidence reveals how

chronic disease saps our health and economic well-being, placing an

unsustainable burden on our nation and our future. Chronic disease

impacts every aspect of our lives, from our children’s ability to learn, to

our nation’s ability to compete in the global market, from our economic

stability to national security.

I worked to reduce the impact of chronic disease on the largest medical

practice in the world – 300 million Americans whom I had the privilege

to serve as U.S. Surgeon General. I remain dedicated to continuing

this effort with every person who will join me. This is a very personal

quest for me. My own parents died before they should have because of

preventable diseases, mirroring the data in this Almanac.

This Almanac is for every person who suffers from chronic disease

and every leader who is working today to make a positive difference

in our health.

Ultimately, our combined efforts for better prevention and disease

management will save lives, save money, and improve the health, safety

and security of every American.

Richard H. Carmona, M.D., M.P.H., FACS 17th Surgeon General of the United States (2002-2006) President, Canyon Ranch Institute Chairperson, Partnership to Fight Chronic Disease

4

introduction

In his address to the nation this year, President Obama was clear in his vision

and forceful in his intent, but realistic about the challenges of health care

reform and the importance of addressing them now despite the competing

demands of the economic downturn and other national priorities.

Some Americans question whether a structural overhaul of the health care

system is something that our nation can afford to undertake right now given

the state of the economy. The 2009 Almanac of Chronic Disease highlights

both the urgency of taking on such a challenge and the opportunities for

improving the sustainability of our health care system by addressing chronic

disease. As you will see in the first few chapters of the Almanac, the path to

successful health care reform goes straight through more effective chronic

disease prevention and treatment.

Rates of chronic disease are higher in the U.S. than anywhere else, and

Americans already spend well beyond what other industrialized nations are

spending on health care, with overall expenditures rising faster than the

GDP. In addition, due to out-of-pocket health care costs that are outpacing

average wages, half of all Americans are going without certain types of

medical care, impeding their ability to treat their chronic health problems

effectively. We cannot afford to stay on this course.

Health care affordability, workforce productivity and quality of life are

threatened by the rise of chronic illnesses like diabetes, heart disease and

asthma, which are in turn driven by increases in risk factors like obesity.

Nationwide, more than 75 cents of every health care dollar – or $1.7 trillion

annually – goes toward the treatment of chronic illness. Putting this number

in the context of the current economy, the sum dedicated to treating chronic

disease in 2007 is equivalent to paying 34 million salaries of $50,000.

Given these trends, simply trying to expand subsidies and other assistance

for health care coverage is not a sustainable solution. If our nation hopes to

slow rising health care costs, policymakers must make changing the trends

in chronic disease – largely a preventable crisis – a key focus of health and

economic reform. With stronger policies in place to encourage lifestyle

changes, and with more effective programs to increase use of preventive

services, health spending and economic growth in the U.S. could look

significantly different – as could the health of all Americans.

Prevention is only part of the overall solution, however. We also need to

promote efficiency and create incentives for increased quality and shared

responsibility to address the huge gaps in effective, coordinated care

for chronic diseases when they occur. We can start by realigning health

system incentives to prioritize efficient chronic care management along


with prevention, creating a health care infrastructure that more effectively

brings together health care payers, employers and providers and holds them

accountable for the prevention, detection, and treatment of chronic diseases.

Improving chronic disease care can help not only to lower projected spending,

but also to increase quality of life, drive greater efficiency, improve health care

outcomes and generate higher value for every health care dollar spent.

A related priority needs to be the elimination of health disparities so that every

American has access to quality health care, regardless of geographic location,

race, age, gender or disability. This also means promoting health across

generations, halting the trend of younger Americans suffering from preventable

chronic diseases at higher rates than their parents did at the same age.

Taken together, these efforts will help close the gaps in health care quality and

outcomes, while also slowing cost growth and improving affordability.

Health care reform cannot succeed on a partisan agenda – nor can it be

successful without addressing chronic disease. Fortunately, as the 2009

Almanac of Chronic Disease demonstrates, there is evidence that taking

action to address chronic disease is an issue that members on both sides of

the aisle can support, and for which there is proven evidence that change will

lead to savings and better value.

Our current economic condition makes this year one of the most challenging

for reforming our health care system, yet it also makes it one of the most

promising. There is real opportunity and momentum for creating an

infrastructure that supports chronic disease prevention and management. For

far too long, we have been unwilling or unable to make the changes we need,

and the toll is all too evident. The future of our economy is tied to the health of

our citizens, and our health is increasingly related to chronic disease prevention

and treatment. Until we succeed in leading healthier lives and delivering better

care to treat chronic disease, our long-term prosperity is at risk.

Kenneth E. Thorpe, Ph.D. Executive Director, Partnership to Fight Chronic Disease; Professor and Chair, Department of Health Policy and Management, Rollins School of Public Health, Emory University; Executive Director, Institute for Advanced Policy Solutions

Mark McClellan, M.D., Ph.D. Director, Engelberg Center for Health Care Reform; Senior Fellow, Economic Studies and Leonard D. Schaeffer Director’s Chair in Health Policy, The Brookings Institution; Former Administrator of the Centers for Medicare and Medicaid Services; and Advisory Board Member, Partnership to Fight Chronic Disease


Chronic illnesses – ongoing, generally incurable illnesses or conditions, such as heart disease, asthma, cancer and diabetes – are

among the greatest threats to Americans’ health. More than 133 million Americans, or 45 percent of the population, have at least

one chronic condition.

Not surprisingly, chronic diseases have become the leading cause of death and disability in the United States. Seven out of every 10

deaths are attributable to chronic disease, and illnesses like heart disease and cancer top the list of most common causes of death.

Chronic diseases also compromise the quality of life of millions of Americans.

Rising rates of chronic diseases pose a significant and growing problem in the United States. As a result of many factors – including

poor lifestyle choices, as well as lack of access or emphasis on preventive care – the incidence of chronic diseases has increased

dramatically over the last three decades. With the growth in obesity – especially among younger Americans – the diagnosis of

childhood chronic diseases has almost quadrupled over the past four decades, and rates of chronic disease are expected to

continue to rise.

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Overviewof Chronic Disease in america

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For the sake of Americans’ health, and to truly change the economics of our health care system, the U.S. must dramatically shift its health care focus toward preventing chronic disease.

Taken from “Call to Action: Health Reform 2009.” Issued by Sen. Max Baucus, D-Mont.

Nearly half of Americans have one or more chronic diseases. (Chart 1)

! Chronic diseases are ongoing, generally incurable illnesses or

conditions such as heart disease, asthma, cancer and diabetes.

These diseases are often preventable, and frequently manageable

through early detection, improved diet, exercise and treatment.

A quarter (26%) of Americans have multiple chronic conditions. (Chart 2)

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Chronic disease is the leading cause of death and disability in

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! Chronic disease is responsible for seven out of every 10 deaths

each year. (Chart 3)! Chronic disease accounted for four of the top five causes of death

in 2005. (Chart 4)

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Chart 4 Top 5 Causes of Death (1980, 2005)

Public hospitals ensure that the nation’s most vulnerable patients receive coordinated care. Public hospitals don’t just treat symptoms; they remove obstacles that often hinder a patient’s ability to manage disease.

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Source: CDC

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Confronting America’s health crisis requires that we support individuals and communities in making better choices. But, it also requires that we work together to address the underlying conditions and other factors that contribute to our declining health and well-being, particularly for those living in communities with limited access to the tools and resources needed to attain and maintain a healthier lifestyle.

Neil Nicoll, President & CEO, YMCA of the USA

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The share of children who are overweight has tripled in the U.S. over

the past two decades. (Chart 5)

! The increase in childhood obesity is placing the next generation at

great risk for developing other chronic diseases earlier in life.

The diagnosis of childhood chronic diseases has almost quadrupled

over the past four decades. (Chart 6)

! According to the Centers for Disease Control (CDC), one in three

children will develop diabetes over their lifetime, given current trends

in overweight or obesity.

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By the year 2023, the incidence of chronic disease is expected to rise

dramatically. (Chart 7)

! Without change, the U.S. will experience a more than 50 percent

growth in cases of cancer, mental disorders and diabetes and more

than 40 percent growth in heart disease.

Across the U.S., obesity has continued to increase sharply, and

contribute to rising rates of other chronic diseases. (Chart 8)

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The nation is facing a worsening health care crisis that demands our immediate attention. As a nation, we spend two trillion dollars a year on care, yet 1 in 2 Americans suffer from chronic diseases that decrease quality of life and increase health costs. Estimates indicate that close to 200 million Americans alive today will have a chronic illness, and that 1 in 4 dollars will soon be spent on health care. Without basic reform, the burden and the cost of treating these chronic conditions will not be sustainable for future generations.

Chronic disease can affect all Americans, and we need to focus on the steps we know will work best. The power of prevention is an essential element of health reform—the best way to address the unsustainable increase in health costs related to chronic conditions is to prevent the conditions in the first place. – Statement of Sen. Edward M. Kennedy, D-Mass., January 22, 2009


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The U.S. health care system is in urgent need of reform, especially when it comes to reducing cost.

Year after year, the amount the nation is spending on health care increases – both at a national level and for individuals and families. In

2007, the U.S. spent over $2.2 trillion on health care. This represents 16 percent of U.S. gross domestic product (GDP): the highest

proportion in U.S. history and a larger percentage of GDP than any other developed country. For many Americans, rising health costs

are jeopardizing the affordability of insurance coverage and leading to high rates of personal bankruptcies.

Without action to contain costs, national and personal health spending is expected to continue to grow and will consume an

increasing share of the U.S. government, and personal, budgets.

The Rapid Rise in Costs in the U.S. Health Care System

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Over the past four decades, U.S. health care spending has increased

substantially. (Chart 1.1)

! In 2007, the U.S. spent $2.24 trillion on health care.

Health care spending is distributed approximately evenly between the

public and private sectors. (Chart 1.1)

! In 2007, private health spending accounted for 53.8 percent of total

health expenditures. Public spending accounted for 46.2 percent.

Absent change, U.S. health spending is predicted to almost double over

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! The Centers for Medicare and Medicaid Services (CMS) predicts

that, without change, total health expenditures will increase at

roughly 6.7 percent annually from 2007-2017.! Based on this prediction, U.S. health spending could reach

$4.3 trillion in 2017.

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Peter Orszag, Former Director, Congressional Budget Office, at the Health Reform Summit of the Senate Finance Committee, June 16, 2008

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We must [address] the crushing cost of health care. This is a cost that now causes a bankruptcy in America every thirty seconds. By the end of the year, it could cause 1.5 million Americans to lose their homes. It is one of the major reasons why small businesses close their doors and corporations ship jobs overseas.

President Barack Obama, February 24, 2009 Address to Joint Session of Congress

Health care represents an ever-growing portion of national

expenditures in the U.S. (Chart 1.3)

! The health share of GDP is anticipated to rise rapidly from 2007 to

2009, largely as a result of the recession, and then climb to 20.3

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funding for health care in 2016 and are projected to pay for more

than half of all national health spending in 2018.

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>The U.S. spends significantly more by far on health care as share of

GDP than any other developed country. (Chart 1.4)

! Switzerland, the country with the next highest health spending as

a percent of GDP, had nearly four percent less of its GDP spent on

health care.! Much of the lower health expenditures in European countries can be

attributed to their investments in primary care.

A health care system which focuses more on repairing the damage done by chronic disease than it does on preventing both the disease and the damage it causes is no health care system at all. It is a “sick care” system. At PhRMA, we believe Americans are entitled to affordable access to the great medicines we make to prevent and manage chronic disease – that would truly be a health care system worth fighting for.

Billy Tauzin, President & CEO, Pharmaceutical Research and Manufacturers of America (PhRMA)


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Despite spending more on health care than any other developed

country, the U.S. is not spending money efficiently. (Chart 1.5)

! In June 2008, the Congressional Budget Office estimated that up to

one-third of 2006 health spending – roughly $700 billion or nearly 5

percent of GDP – did not improve Americans’ health outcomes.

Health care costs are also straining American families’ budgets. (Chart 1.6)

! Out-of-pocket spending has increased 27 percent over the last

five years.! Private health insurance expenditures have risen almost 43 percent

over the same time period.

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The primary driver of soaring health care costs is inadequate investment in prevention, health risk reduction and disease management. These programs do not cost too much, but rather it is far too costly not to implement them.

Anthony C. Wisniewski, Executive Director of Health Policy, U.S. Chamber of Commerce, Founder and Co-Chair, U.S. Workplace Wellness Alliance

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It’s the number one fiscal challenge for the federal government, it’s the number one fiscal challenge for state governments and it’s the number one competitive challenge for American business. We’re going to have to dramatically and fundamentally reform our health care system in installments over the next 20 years. And if we don’t, it could bankrupt America.

David Walker, Former U.S. Comptroller General, July 8, 2007 Interview with “60 Minutes”

Nearly half of U.S. debtors in 2001 met at least one criterion to classify

as declaring “major medical bankruptcy.” (Chart 1.7)

! The criteria for major medical bankruptcy were: (1) citing illness or

injury as a specific reason for bankruptcy, (2) reported uncovered

medical bills exceeding $1,000 in the past years, (3) lost at least

two weeks of work-related income because of illness/injury or (4)

mortgaged a home to pay medical bills.

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While rising health care costs are often attributed to many different things, research shows that chronic diseases are a major

contributor to rising health care spending in the United States. Of each dollar we spend on health care nationwide more than 75

cents – or about $1.7 trillion annually – goes toward the treatment of chronic illness. In addition to treatment costs, chronic diseases

also take a toll on the nation’s economy by lowering productivity and slowing economic growth.

High health care costs can have a significant impact on the likelihood that Americans will be able to effectively managing their

chronic conditions. High costs are causing many Americans to forgo certain types of medical care – and this can harm their ability

to effectively treat their chronic health problems. Complications due to the mismanagement, under-treatment or underdiagnosis of

chronic diseases will only add to the rapidly increasing costs and heavy burden associated with these long-lasting diseases.

The Role of Chronic Disease in Higher Health Costs and Lower U.S. Economic Growth

2


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The single greatest cause of rising health care spending in the U.S. is

rising prevalence of chronic disease. (Chart 2.1)

! About two-thirds of the rise in health care spending from

1987-2002 ($453.3 billion) is due to the rise in the prevalence of

treated chronic disease.

Treatment of patients with one or more chronic diseases is responsible

for 75 percent of total health spending in the U.S. (Chart 2.2)

! In 2007, health care costs associated with patients with one or more

chronic diseases amounted to approximately $1.7 trillion.

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The American Academy of Nursing strongly believes that it is in our country’s best interest to examine all research-based solutions that meet the overall needs of each patient and widely adopt those models of care that result in lower costs and a healthier population.

Pat Ford-Roegner, MSW, RN, FAAN CEO, American Academy of Nursing


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The United States cannot effectively address escalating health care costs without addressing the problem of chronic diseases. – U.S. Centers for Disease Control and Prevention (CDC)

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When put into perspective against other levels of spending inside and

outside the United States, our country’s spending on health care and

chronic disease is substantial. (Chart 2.3)

! Health care spending in the U.S. is twice its spending on food. ! U.S. spending on patients with one or more chronic diseases is

larger than all of China’s personal consumption.

Promoting healthy lifestyles and preventing chronic disease will not be accomplished quickly or simply. Achieving these goals will require a comprehensive approach that, rather than focusing on sickness, encourages healthy lifestyles and integrates healthy choices into individual’s daily lives.

Sen. Tom Harkin, D-Iowa, June 18, 2008

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As in many things in health care and health spending, American “exceptionalism” is the rule: The United States is doing an especially rotten job of delivering chronic care, at spectacular cost.

Susan Dentzer, Health Affairs Editor-in-Chief. Taken from Health Affairs, “Reform Chronic Illness Care? Yes, We Can”

Federal spending on patients with chronic conditions is quite high when

compared to other federal expenditures. (Chart 2.4)

! Federal spending in 2008 in Medicare and Medicaid on patients with

one or more chronic conditions is:

32 times the amount of money given to automakers in the 2008

Congressional bailout

Eight-tenths of the amount of money given to U.S. banks by

Congress in 2008

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Older Americans (those age 50 and above) are diagnosed with and treated

for certain chronic illnesses more often than their European counterparts

are. (Chart 2.5)

! Disease and treatment rates are higher in the United States

than elsewhere, according to a study published in Health Affairs, and

may add as much as $100 to $150 billion in treatment costs to U.S.

health spending.! The high U.S. prevalence of obesity and related conditions, such as

heart disease, cancer and diabetes, suggests that measures designed to

prevent these conditions could yield lower spending in the United States.

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There are several reasons why disease treatment rates might be higher in the United States. First, higher rates of obesity and, up until the 1970s, smoking place Americans at higher risk for a number of chronic conditions. Second, the U.S. medical system might have a greater propensity to screen for disease more aggressively and treat less severe cases of disease.

Excerpt from “Differences In Disease Prevalence As A Source Of The U.S.-European Health Care Spending Gap,” Health Affairs

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High rates of obesity and overweight in the U.S. are not just a public health issue – they are an issue of national security. If our society is not physically fit, we will not be able to defend ourselves and our country’s common interests.

John Robitscher, Executive Director, National Association of Chronic Disease Directors

The U.S. spends more per capita annually on health care for obese

Americans than normal weight Americans. (Chart 2.6)

! On average, health care spending for an obese individual is $1,069

higher per year than spending for someone of normal weight.

Over their lifetime, obese Americans spend more than normal weight

Americans, even though they will live about as long. (Chart 2.7)

! An obese seventy-year-old will live about as long as a peer at

normal weight, but will spend on average $39,000 more on

health care.

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Due to high health care costs, over half of Americans (53%) have

forgone certain types of medical care – and this can harm their ability to

effectively treat their chronic health problems. (Chart 2.8)

! Almost one in four Americans skipped a recommended medical test

or treatment because of cost.! One in four Americans have put off or postponed getting health care

they needed because of cost.

Almost half of Americans (46%) who said their household had “put off

or postponed getting health care [they] needed” had delayed preventive

care or put off care for a more serious problem, either a doctor’s

visit related to a chronic illness such as diabetes or a major or minor

surgery. (Chart 2.9)

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Source: Kaiser Health Tracking Poll

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Having a continuous source of health insurance matters a great deal to

chronically ill patients’ abilities to stick with their treatments. (Chart 2.10)

! Among working age adults suffering from at least one chronic condition,

those who were uninsured at some point in time were more than three

times as likely as those who were insured throughout to skip a dose or

not fill a prescription because of cost.

Almost 60 percent of families who declared medical bankruptcy cited

chronic diseases as the primary reasons for doing so. (Chart 2.11)

! Medical debt is most common among low-income individuals and

families, even those with insurance, and interferes with access to care.! According to Health Affairs, at least 8 percent, and perhaps as many as

21 percent, of American families are contacted by collection agencies

about medical bills annually.

At Canyon Ranch Institute, we are collaborating with communities and leaders in the fight against chronic disease. We focus on underserved communities where preventable chronic disease is most prevalent. A one-size-fits-all approach to wellness does not succeed, so we embrace the privilege of collaboration to ensure that programs are health literate and relevant within communities.

Jennifer Cabe, M.A., Executive Director, Canyon Ranch Institute

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! The amount of lost productivity due to seven of the most common

chronic diseases, or $1 trillion, could have paid for:

20 million jobs at a salary level of $50,000,

13.3 million jobs at a salary level of $75,000, or

8 million jobs at a salary level of $125,000.! As of January 2009, 11.3 million Americans were unemployed,

according to the Bureau of Labor Statistics.

Health spending related to chronic diseases is dwarfed by the indirect

costs of these health problems. (Chart 2.12)

! Seven of the most common chronic conditions alone accounted for

$1 trillion in lost productivity in 2003.

Some chronic diseases are more costly than others. (Chart 2.13)

! Cancer and hypertension are among the most costly chronic

conditions, accounting for over $500 billion annually in treatment

expenditures and lost economic output.

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Our country risks losing its status as a world leader if we cannot solve our systemic health care problems soon. Absent significant investments in a new health care delivery model, the United States likely will suffer even greater adverse economic consequences as a result of the ever increasing prevalence of costly chronic conditions, requiring greater percentages of GDP to be devoted to health care expenditures.

Tracey Moorhead, President & CEO, DMAA:The Care Continuum Alliance

Without better prevention or disease management, rising rates of

chronic conditions in the U.S. have the capacity to significantly impact

our GDP growth.

! If left unchecked, these seven chronic diseases alone could cost the

U.S. almost $6 trillion in foregone economic output by 2050.

(Chart 2.14)

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An increase in chronic disease among the American workforce is threatening to harm the global competitiveness of U.S. businesses.

Businesses are the primary providers of health insurance in the U.S., yet rising health care costs are making it increasingly difficult

for them to provide coverage to all their employees. Employee health benefits are the fastest growing cost component for employers

and represent an increasingly large percentage of payrolls. The increasing prevalence of chronic conditions within the U.S. workforce

is one of the primary reasons for these trends.

Not only does a sicker American workforce have higher health care costs, but it is also less productive. Chronic illnesses lead

to absenteeism and presenteeism – or decreased effectiveness while present at work. These problems represent real loses of

productivity for U.S. businesses.

In an effort to contain rising health care costs and boost productivity, many companies are taking active steps to prevent and reduce

chronic diseases, including implementing workplace wellness programs.

The Burden of Chronic Disease on Business and U.S. Competitiveness

3

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%)!78.*&L

At the same time businesses are struggling to avoid layoffs, pay cuts, and benefit reductions, employee health care costs are skyrocketing. Without an investment in health reform, employers may be forced to reduce or eliminate benefits or may be driven out of business because of their inability to compete in the global marketplace.


Employers provide the majority of health insurance for non-elderly

adults in the United States. (Chart 3.1)

! In 2007, 162.5 million Americans received employer-based coverage.

Over the past decade, employer and employee contributions for health

insurance have increased significantly. (Chart 3.2)

! The total cost of coverage doubled between 1999 and 2008, with

employer contributions increasing from $154 to $332 and employee

contributions increasing from $35 to $60.

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Medically related benefits make up nearly one-third of all benefits costs and average approximately 10 percent of gross payroll.Source: U.S. Chamber of Commerce

36


%)!78.*&L

The urgent challenge facing all Americans to find a healthier lifestyle demands a fundamentally new and aggressive social response. Individually, each of us must take responsibility – and help our children and families take responsibility – for healthy living. Collectively, all sectors of our communities and nation must come together to advance a common strategy to remove the barriers and increase the opportunities for healthy lifestyles for individuals and families.


Approximately two-thirds of employers continue to offer health benefits

to their employees, but the overall rate has slightly decreased as health

costs have increased. (Chart 3.3)

! In a 2008 survey, 48 percent of small firms with less than 200

workers listed high premiums as the most important reason for not

offering health benefits.

Source: The Kaiser Family Foundation Health Research Education Trust

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Source: The McKinsey Quarterly

In 2005, Starbucks announced it was spending

more on employee health benefits than coffee. In

2009, rather than cut health benefits, Starbucks

announced it would lay off 6,000 employees and

close 300 stores.Source: Associated Press

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For the United States to continue to be an economic leader worldwide, supported by a healthy and productive workforce, more attention needs to be directed toward health promotion and disease prevention.

Taken from Health Affairs, “Do Prevention Or Treatment Services Save Money? The Wrong Debate” by Ron Goetzel, Ph.D. Professor and Director of the Institute for Health and Productivity Studies, Emory University

The U.S. has a higher hourly cost of health benefits in the

manufacturing industry than other developed countries. (Chart 3.4)

! U.S. hourly health benefits costs were $2.38 per worker per hour in

the manufacturing industry – considerably higher than the foreign

trade weighted average of $.96 per worker per hour.

Source: The Heritage Foundation

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GM, Ford, and Chrysler spend more on employee

health expenses than on the steel they use to

make cars. The cost of providing health care

added $1,100 to $1,500 to the cost of each of the

4.65 million vehicles GM sold in 2004, according

to various calculations.Source: USA Today


%)!78.*&L

In today’s economically challenging times, investment in disease prevention makes even more sense than ever before. The health outcomes alone are compelling when people are empowered and educated to make healthy choices – at home, at work, in all schools, within our health systems, and in communities.


American workers experience high rates of chronic disease. (Chart 3.5)

! Almost 80 percent of workers have at least one chronic condition.! 55 percent of workers have more than one chronic condition.

Overweight workers incur larger medical costs and miss more days of

work than normal weight coworkers. (Chart 3.6)

! Severely obese women are absent more than twice as often as

normal weight women.! Severely obese workers have greater rates of workers compensation

claims than workers who weigh in at the recommended weight.

Source: Archives of Internal Medicine

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We are called by our mission to help all Americans lead healthier lives. Sixty-four million U.S. households live within three miles of a YMCA, making us a powerful force to advance creative and collaborative efforts to turn the tide of America’s growing health crisis.


Worker productivity losses from missed workdays (absenteeism) and

reduced effectiveness at work due to illness (presenteeism) are closely

linked to problems with chronic illness. (Chart 3.7)

! Presenteeism is responsible for the largest share of lost economic

output associated with chronic health problems.

Many employees report going to work despite being sick and most

say they are not as productive.

! 21 percent of workers report that they have gone to work despite

being sick or dealing with a non-work issue six or more days in the

last six months.! When asked, employers list chronic conditions as the biggest

reason for presenteeism.

Source: American Institute of Certified Public Accountants

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Absenteeism is defined as work missed due to sick days.

Presenteeism is defined as the lost productivity that occurs when employees come to work but perform below par due to any kind of illness.


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We have both a moral and fiscal responsibility to get chronic illnesses – and the costs associated with them – under control. Moreover, we have a body of growing evidence that demonstrates ways to provide better family-centered care and prevent chronic illnesses.

Pat Ford-Roegner, MSW, RN, FAAN CEO, American Academy of Nursing

Depression is the greatest cause of productivity loss among workers.

(Chart 3.8)

Workers with chronic conditions are more likely to miss work than

peers without a chronic disease. (Chart 3.9)

! Older workers with more than one chronic condition on average

miss 1.5 times more work days than younger workers who also have

more than one chronic condition.

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It is true that new and re-emerging health threats such as SARS, avian flu, HIV/AIDS, terrorism, bioterrorism and climate change are dramatic and emotive. However, it is preventable chronic disease states that will send health systems and economies to the wall.

Stig Pramming, Executive Director, Oxford Health Alliance at 5th Annual Oxford Health Alliance Conference

Certain chronic illnesses are particularly costly to business. (Chart 3.10)! The most expensive conditions in terms of presenteeism are arthritis,

hypertension and depression.

Mental illness can worsen the burden of chronic disease at the

workplace (Chart 3.11)

! When a worker with a chronic illness also has a mental health

disorder, they are more likely to miss work than peers who do not.

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The combination of the aging U.S. workforce, chronic disease and the market crisis led to a situation where health care costs must be addressed immediately to avoid increased taxes, reduced benefits, or draining other vital programs to pay for health care.


Family caregivers are a critical support structure for Americans with

chronic illnesses, and the U.S. health care system. (Chart 3.12)

! Family caregivers provide 80 percent of all long-term care services

for chronically ill patients.! In any given year, more than 50 million Americans find themselves in

a caregiving role

Source: Agency for Healthcare Research and Quality (AHRQ)

Employers are also affected when workers are the primary caregivers

for family members with chronic conditions. (Chart 3.13)

! Employers can lose as much as $33 billion each year due to

employees’ need to care for loved ones age 50 or older.

Source: Metlife Mature Market Institute and National Alliance of Caregiving

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Companies are increasingly looking to address chronic disease as a

means of improving the health of their employees and reducing health

care costs. (Chart 3.14)

! In just one year (2006-2007), the percentage of companies tracking

the chronic health conditions prevalent in their workforce increased

from 43 percent to 77 percent, among a sample of employers

tracked by Hewitt Associates.

Our efforts at reform must include a new focus on prevention, wellness and chronic disease. Health care should be about fostering good health, not just treating illness. We are gaining knowledge about how to prevent and manage diseases. If we expand and apply that knowledge, we can improve health outcomes and decrease the cost of health care.

Taken from hearing statement of Sen. Max Baucus, D-Mont., June 3, 2008

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Many employers think that using wellness programs will be effective at

both improving health and reducing costs. (Chart 3.15)

! Overall, 64 percent of firms think wellness programs will be effective

at improving health and 44 percent of firms think they will be effective

at reducing costs.

U.S. employers are driven by different goals than global firms when it

comes to primary reasons for offering wellness programs. (Chart 3.16)

! U.S. employers, when compared to employers from Canada, Europe

and Asia/Africa/South America, were the only group to cite reducing

costs as their primary reason for offering wellness programs.

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Chart 3.16 Relative Importance of Wellness Program Objectives – By Geography*

* Ranking determined from “Important” and “Very Important” responsesSource: Buck Consultants

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PhRMA, and many of our member companies, support innovative workplace wellness programs across the country. In addition, we are making investments in programs for our own employees. Good companies are focused on the well-being of their employees and profitability of their company.


54 percent of firms that offer health benefits offer at least one type of

wellness program. (Chart 3.17)

! The most common wellness programs offered are gym memberships

or discounts on exercise facilities and web-based resources for

healthy living.

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The majority of employees support employer-based weight

management programs, particularly the policy of favorable tax

treatment for providing exercise facilities. (Chart 3.18)

Certain indicators suggest that employer interest in wellness programs has increased considerably within the last year.! Membership in the U.S. Workplace Wellness

Alliance, an organization dedicated to creating a healthier U.S. workforce to allow for competition in the global marketplace, has more than tripled since May 2008.

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The growing prevalence of chronic disease nationally is especially hard on our nation’s employers, who need timely and relevant information about strategies to improve workforce health and to lower health care costs. Employee health and health benefits should be a fundamental part of every employer’s strategic business model – not just an unavoidable cost to manage. Employers recognize the need for business strategies that respond to increasing health costs associated with chronically ill employees and dependents.

Tracey Moorhead, President & CEO, DMAA: The Care Continuum Alliance

48

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Millions of Americans receive their health care coverage through the public health insurance programs Medicare and Medicaid. These

programs represent a disproportionately large share of total health spending in the U.S. and, in the last decade, expenditures in these

programs have risen dramatically.

Increasing costs appear to be linked with rising rates of chronic disease and the tremendous growth in rates of obesity and

overweight. Chronic diseases now account for the vast majority of spending in both programs: 99 percent in Medicare, and 83 percent

in Medicaid.

Evidence suggests this precipitous spending increase could be significantly reduced for a small, long-term per capita investment.

According to Trust for America’s Health, for an annual investment of $10 per American in community-based disease prevention programs,

in 20 years Medicare could save $6 billion annually and Medicaid could save $2 billion annually over the same time period.

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The Impact of Chronic Disease on Public Health Insurance Programs

4

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The first baby boomer will reach 62 and be eligible for early retirement of Social Security January 1, 2008. They’ll be eligible for Medicare just three years later. And when those boomers start retiring in mass, then that will be a tsunami of spending that could swamp our ship of state if we don’t get serious.

David Walker, Former U.S. Comptroller General, July 8, 2007 Interview with “60 Minutes”

Public health insurance programs provide coverage to millions of

Americans. (Chart 4.1)

! Public programs, such as Medicaid and Medicare, covered slightly

more than one quarter of the population in 2007. ! Those covered by these programs are, on average, poorer, older and

sicker than Americans covered by private insurance.

Public health insurance programs represent a disproportionately large

share of total health spending. (Chart 4.2)

! While they cover a quarter of all Americans, they accounted for

almost half of the $2.2 million of national health spending in 2007 –

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One of the reasons prevention doesn’t happen in this country is because we don’t pay for it. In fact, in Medicare and Medicaid we refuse to pay for it. We refuse to pay for prevention. The only way we’re going to bring that number down is through prevention, preventing chronic disease instead of just retreating it.

Sen. Tom Coburn, R-Okla., Senate Health, Education, Labor and Pensions (HELP) Committee Hearing, January 8, 2009

Medicare and Medicaid expenditures have risen dramatically in the last

decade. (Chart 4.3)

! Both Medicare and Medicaid expenditures have more than doubled

over the last decade.

Federal spending on Medicare and Medicaid is projected to surpass

other areas of spending in the next two decades. (Chart 4.4)

! By 2075, spending for Medicare and Medicaid is projected to

amount to 15 percent of non-interest expenditures. Today, the core

costs of the entire federal government – ignoring net interest on the

debt – are approximately 18 percent of GDP.

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In an economic downturn, state and local health departments act as a safety net for individuals and families who have lost their health coverage and are searching for access to basic health services. Funding for prevention and wellness can strengthen our public health infrastructure and our workforce while building stronger, healthier communities.


Medicaid accounts for a significant portion of state spending. (Chart 4.5)

! Medicaid is the second largest line item in state budgets. On average,

17 percent of state funds are allocated to Medicaid.

Patients with one or more chronic conditions account for the vast majority

of Medicare and Medicaid spending in public health insurance programs:

(Chart 4.6)

! 99% of spending in Medicare! 83% of spending in Medicaid

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In the past, most efforts to slow Medicare spending growth focused on cutting payments to hospitals, physicians and other health care providers. These research findings suggest policymakers should direct their attention toward programs that encourage healthier lifestyles among seniors and those nearing retirement.

Kenneth E. Thorpe, Ph.D., Executive Director, Partnership to Fight Chronic Disease

Within Medicare, growth in spending is linked to growing rates of

treated chronic disease. (Chart 4.7)

! Since 1987, the prevalence of treated chronic disease has risen

steadily for five common conditions.

Patients with multiple chronic conditions account for the vast majority

of spending within Medicare. (Chart 4.8)

! In 1987, Medicare beneficiaries with 5 or more chronic conditions

accounted for approximately 50 percent of spending.! By 2002, three-quarters of spending (76%) was attributable to this

group of beneficiaries.

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Were obesity still at 1987 levels, Medicare spending would be $40 billion per year lower than it was in 2006, and total U.S. spending would be $210 billion less per year. Source: Health Affairs

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Carolinas Healthcare acts as a care navigator, ensuring that Medicaid patients with chronic diseases do not fall through the health system’s cracks when they move from a primary care physician, to a specialist, to a hospital. Over the past nine years, the North Carolina model of enhanced primary care– saving the state nearly half a billion dollars.

Allen Dobson, M.D., Vice President, Carolinas Healthcare System

Across the U.S., obesity and overweight represent nearly 10 percent of

spending in health care. In public insurance programs, the percentage of

spending is slightly higher than in private programs. (Chart 4.9)

! Obesity accounts for 9.1 percent of total annual U.S. medical

expenditures in 1998 and may be as high as $78.5 billion ($92.6

billion in 2002 dollars). ! Medicare and Medicaid finance approximately half of these costs.

Source: Health Affairs

Obesity is a major – and growing – driver of spending in Medicare.

(Chart 4.10)

! Between 1987 and 2002, the percentage of Medicare beneficiaries

who were obese doubled – rising from 12 percent to 23 percent.

! Over that same time, Medicare spending on obese beneficiaries nearly

tripled – rising from 9 percent to 25 percent of total spending.

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On the national level, spending in Medicare and Medicaid could be

significantly reduced for a small per capita investment. (Chart 4.11)

! For an investment of $10 per American in community-based disease

prevention programs, Medicare could save between $487 million

to $6 billion annually in one to 20 years. Medicaid could save $370

million to $2 billion annually over the same time period.

Some states have created disease management or prevention initiatives

in order to reduce cost and improve health. (Chart 4.12)

There is still room for improvement: Less than five percent of state

health department budgets is directed at preventing and controlling

chronic diseases.

Source: ASTHO

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Chart 4.12 Distribution of Chronic Disease Prevention and Management Programs

Source: ASTHO

In the past decade, more than twenty state Medicaid agencies have instituted chronic disease management programs.

In 2005, 38 states covered some tobacco-dependence counseling or medication for all Medicaid recipients. Four more states offered coverage only for pregnant women.Source: National Council of State Legislators

58

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The hospital-to-home model, in which advanced practice nurses work with patients, families, and their health care teams to ensure a smooth transition, has repeatedly shown reductions in hospitalization rates, improvements in functional outcomes and enhancement in satisfaction among participants, their families and their physicians. Most strikingly, this care model saves approximately $5,000 per Medicare patient as compared to a patient receiving standard care. – Pat Ford-Roegner, MSW, RN, FAAN, CEO, American Academy of Nursing

I am establishing a Chronic Care Management Commission that will be responsible for developing the process to effectively manage chronic disease across the state. About 78 percent of all health care costs can be traced to 20 percent of all patients – those with chronic diseases. We cannot reduce the occurrence and cost of chronic diseases without aggressively addressing prevention, detection and treatment in a comprehensive, pro-active way. – Pennsylvania Gov. Ed Rendell, May 21, 2007

The prevalence of chronic disease within our senior population has already increased national health care spending, high rates of disability, and much human suffering. The problem, then, only stands to become exponentially worse as our elderly population grows. – The Silver Book: Chronic Disease and Medical Innovation in an Aging Nation


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Sources

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Chronic disease prevention and management holds great promise for reducing our nation’s health care spending. But right now, far

too little is being invested in improving Americans’ health and effectively preventing and managing common and costly chronic health

problems. In fact, American investment in this area of health care is startlingly scarce: It is estimated that less than 1 percent of the

$2.2 trillion spent on health care goes toward prevention.

Well-designed disease prevention and management programs are proven to yield economic and health benefits, especially if

implemented in communities, schools and the workplace. Programs designed to change poor health behaviors – such as those to

reduce smoking or improve medication adherence – have been shown to reduce costs and improve health.

It is critical that we take steps to spend more wisely and effectively when it comes to treating, managing and preventing disease.

Improvements in personal health behaviors and investment by business and the health care system in population health improvement

could save millions of lives, and trillions of dollars.

Boosting U.S. Health and Prosperity by Reducing Chronic Disease

5

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Already, we have done more to advance the cause of health care reform in the last thirty days than we have in the last decade. […] Our recovery plan [makes] the largest investment ever in preventive care, because that is one of the best ways to keep our people healthy and our costs under control.

President Barack Obama, February 24, 2009 Address to Joint Session of Congress

Studies show that, by reducing chronic disease rates, the U.S. can find

significant savings for our health care system. (Chart 5.1)

! By more effectively preventing and managing just seven of the most

common chronic diseases, the U.S. could avoid billions of dollars in

direct, avoidable health care expenditures.! For instance, by taking steps to better prevent and manage heart

disease, the U.S. could decrease health care costs by $76 billion

by 2023.

Better prevention and management of chronic illness could also

stimulate the economy by increasing productivity. (Chart 5.2)

! By 2023, the U.S. could save over $1 trillion in direct and indirect

costs on seven of the most common chronic diseases by taking

action to improve prevention and disease management.

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Despite the economic and health benefits of prevention, U.S. investment

in prevention is dismal. (Chart 5.3)

! Less than one percent of total health care spending in the U.S. goes

toward prevention.

Too few patients are treated according to guidelines – a problem that

costs not only money, but also lives. (Chart. 5.4)

! Increasing the use of just five preventive services from their current

rates to 90 percent would save more than 100,000 lives each year in

the U.S.

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Health care in America is reactive and is geared towards intervening in catastrophic situations, when what we should be doing is focusing on preventing them. The whole system is upside down. It’s like we’re focused on putting Humpty Dumpty back together again instead of keeping him from falling off the wall.

Former Arkansas Gov. Mike Huckabee, May 2008 Interview with Revolution Health

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The reality is, our most effective health care reform opportunity lies in the area of prevention, wellness and chronic disease management. [...] After all, wellness and prevention are key to reducing costs, reducing medical claims filed, and reducing the number of procedures performed, and keeping people healthy.

Iowa Gov. Chet Culver, Condition of the State Speech, January 2008

Chronically ill patients are not receiving recommended preventive care.

(Chart 5.5)

! Chronically ill patients receive the clinically recommended preventive

health care services only 56 percent of the time.

Lack of adherence to recommended medications to treat chronic illness

is driving up healthcare costs and hurting the U.S. economy. (Chart 5.6)

! The economic impact of non-adherence is about $100 billion

annually, including costs from nursing home admissions and

avoidable hospitalizations.

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Disease management and population health improvement strategies have produced well documented clinical and financial benefits in innovative state Medicaid programs. Reform efforts, however, must allow for flexibility in program design and execution – one size definitely does not fit all with public sector populations.

Tracey Moorhead, President & CEO, DMAA: The Care Continuum Alliance

Improving patient adherence can deliver significant value.

(Chart 5.7 and 5.8)

! Greater adherence to diabetes medicines reduces health care

spending. $1 more spent on diabetes medicines = $7.10 less spent

on other services.! Greater adherence to blood pressure medications among at-risk

populations reduces hospitalizations and saves lives.

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A smart investment in community-based prevention targeting the most

prevalent chronic illnesses could go a long way. (Chart 5.9)

! Spending just $10 per person per year on chronic disease prevention

programs would save the U.S. more than $16 billion within 5 years. ! For every dollar spent on proven prevention programs, the U.S.

health care system would save $0.96 in the first two years, $5.60

after five years, and $6.20 after 10-20 years.

Community-based lifestyle programs can prevent or delay the onset of

common and costly chronic diseases, like diabetes. (Chart 5.10)

! The Diabetes Prevention Program (DPP), which is now being

implemented across the country by the YMCA, found that

participants who lost a modest amount of weight through lifestyle

interventions, such as dietary changes and increased physical

activity, sharply reduced their chances of developing type 2 diabetes. ! Results showed that community-based lifestyle interventions have an

even greater impact than medication regimens.

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Chart 5.9 National Return on Investment of Spending (ROI) for Investments of $10 Per Person on Prevention (Net savings in 2004 dollars)

Source: Trust for America’s Health

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At the New York City Health and Hospitals Corporation, we’ve harnessed the power of information technology to better manage the care of more than 50,000 adult diabetics. By using an electronic disease registry, we have a real-time snapshot of the health status of every diabetic patient under our care, allowing clinicians to provide laser focused patient care and avert serious conditions which result from uncontrolled diabetes.

Alan Aviles, President and CEO, New York City Health and Hospitals Corporation

Workplace health promotion programs help employers manage health

care costs and improve productivity: (Chart 5.11)

! A recent study showed that workplace wellness programs decreased

health care costs, absenteeism and workers compensation claims

Recently, more companies are offering on-site clinics, which offer

significant savings. (Chart 5.12)

! An on-site clinic that serves 1,000 employees can save the company

$70,000 in the first year by fewer emergency room visits and self-

referrals to specialists. These savings can rise to $250,000 annually

by the third year.

Source: Wall Street Journal

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Promoting health in schools can be an effective and low-cost way to

establish healthy behaviors for life. (Chart 5.13)

! One study found that investing $14 per student per year would

prevent an estimated 2 percent of the female students from

becoming overweight adults. As a result, society could expect to

save an estimated $15,887 in medical care costs and $25,104 in

increased productivity per student.

Chart 5.13 Annual per Capita Future Return on Investment in “Planet Earth”, a Student Obesity Reduction Program

Source: CDC

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For just $3-4 per student, the “Shape Up Somerville” program in

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dietary choices for first to third graders. Prior to the intervention,

Tufts researchers found that 46 percent of Somerville’s first

to third graders were obese or overweight based on the BMI

for age percentile. After one year of Shape Up Somerville, on

average the program reduced one pound of weight gain over 8

months for an 8-year-old child.

Partnership to Fight Chronic Disease. Keeping America Healthy: A Catalog of Successful Programs. June 2008.

%)!78.*&6

We can build consensus around common principles, set aside small differences, and together transform our culture from one that focuses only on treating illnesses after they occur to one that embraces and incentivizes prevention and management of chronic disease.

Richard H. Carmona, M.D., M.P.H., FACS 17th Surgeon General of the United States (2002-2006) President, Canyon Ranch Institute Chairperson, Partnership to Fight Chronic Disease

Recommended programs to stimulate the economy and reduce obesity include:

Improving Food Quality

! Provide loans/grants to revitalize family farming

! Establish local farm-to-community food distribution systems

! Build community produce gardens

! Build fully functional school kitchens, which too often are equipped

only for microwaving or deep-frying food

Promoting a Physically Active Lifestyle

! Expand sidewalks, pedestrian paths, and car-free urban zones

! Build bike paths and lanes, and establish bicycle loan stations at

convenient locations

! Build parks, sports facilities, swimming pools, and indoor

recreational facilities

! Establish nature preserves with hiking trails

! Build integrated public transportation systems that support a

healthy lifestyle by linking bike paths, recreational facilities, farmer’s

markets, etc.

Comprehensive Approaches

! Build/enhance community health centers to provide inexpensive,

nutritious meals, recreational facilities, and counseling/education at

one location

! Fund integrated, school- and community-based obesity

prevention projects

Source: JAMA

Collectively, lifestyle interventions are a proven tool for improving health

while reducing costs.

! According to a recent report in the Journal of the American Medical

Association (see inset), community-based interventions can quickly

stimulate the economy while reducing obesity in the long-run.


70

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Every country starts at the base of the pyramid with primary care, and they work their way up until the money runs out. We start at the top of the pyramid, and we work our way down until the money runs out. And so few people get good primary care and wellness.

And so we have to change the pyramid. We have to start at the base. And if we’re going to do that, it has to be pervasive. It has to be part of the goal of the Department of Education, the Department of Defense. It has to be the goal of the Department of Commerce.

It has to be the goal, in other words, of everyone so that we can market the idea of wellness. […] We’ve got to make prevention hot and wellness cool.

And I think that it’s really important for us to build that perception of prevention and wellness in a way that actually is part of all aspects of our lives, our workplace, our school, our buildings, and find ways of which to make wellness easier. – Sen. Tom Harkin, D-Iowa, Senate Health, Education, Labor and Pensions (HELP) Committee Hearing, January 8, 2009


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Sources

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Some believe that the economic downturn has slowed momentum for health reform, but the evidence suggests just the opposite.

For most Americans, health care is as much an economic issue as one of personal health. As health care costs continue to soar, the

public is more eager than ever for relief.

Most Americans say that the cost of health care is their top concern. When it comes to reforming health care to reduce cost, they

endorse policies that aim to fight the crisis of chronic disease and strongly support increasing the share of health care dollars devoted

to prevention and wellness.

Americans want policymakers to make health care more affordable, more accessible, and improve the quality of care delivered.

When it comes to achieving these goals, Americans are most supportive of policies built around fighting chronic disease, and they

are calling for change now.

The Groundswell of Public Support for Fighting Chronic Disease

6

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Americans are anxious for health reform:

! Despite the economic downturn, health care remains a top issue,

and was “the major issue” or “one of the major issues” for 58 percent

of voters in November 2008, according to a Partnership to Fight

Chronic Disease survey. (Chart 6.1)! Similarly, surveys by Kaiser Family Foundation since 2004 have

consistently found that more Americans are worried about their

health care costs than about losing their job, paying their rent or

mortgage, losing money in the stock market, or being the victim of a

terrorist attack or a violent crime.

Source: Kaiser Family Foundation

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A recent survey by the National Association of Chronic Disease Directors found that 67 percent of Americans are worried about being able to afford necessary health care.Source: National Association of Chronic Disease Directors


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As a former Congressman, I understand the importance of bipartisanship in policymaking. Fortunately, helping Americans get and stay healthy by actively preventing and managing chronic disease is neither a Democratic or Republican issue. It’s an American issue – and one that makes sense for us to act on today.


The public’s desire for health reform is closely tied to economic

concerns:

! When it comes to health care, affordability is the top priority for most

Americans. (Chart 6.2)! Nearly two-thirds of voters agree that, given the economic downturn,

“it is more important than ever to take on health care reform.” This is

twice the percent who believe the country cannot tackle this issue in

the current economic climate. (Chart 6.3)

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The ultimate objective of the health care system is to improve health. Despite the resources that the nation devotes to treating diseases, the results in terms of health gains are mixed, and many investments that can foster better health – such as preventive medicine – are underused.

Peter Orszag, Former Director, Congressional Budget Office, Statement before the Senate Budget Committee, June 21, 2007

Americans want to see a greater investment in chronic disease

prevention:

! More than four in five Americans favor increased investment in

programs to help prevent chronic disease. (Chart 6.4)! Two thirds say they’re willing to pay higher taxes to fund them.

(Chart 6.5)

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Promoting healthy lifestyle choices around increased physical activity and healthy nutrition are more cost effective approaches to reducing this epidemic. There are clear opportunities for successful interventions as outlined in the National Association for Chronic Disease Directors’ State Success Stories www.chronicdisease.org.


Americans are calling on Congress to take action:

! More than two-thirds of Americans say our health care system

should place greater emphasis on prevention. (Chart 6.6) ! Two-thirds of Americans believe Congress is not doing enough to

keep Americans healthy and promote health and wellness.

(Chart 6.7)

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Approximately 4 in 10 Americans (43 percent) say they are more likely to vote for candidates who favor increased public health spending.Source: National Association of Chronic Disease Directors

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With investments in prevention and disease management, we can improve not only our nation’s health but our safety, quality of life and economic security today and for future generations. That’s why we need the President’s leadership on this issue, and ask that he work with our organization and other like-minded groups to advance comprehensive health reform to address this crisis.

Kenneth E. Thorpe, Ph.D., Executive Director, Partnership to Fight Chronic Disease

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Americans are highly supportive of health reform efforts

that focus on chronic disease prevention and management,

and want their nation’s leaders to pay more attention to the

issue: (Chart 6.8)

! When asked about what would make the most difference

to improving health care in the U.S., respondents

identified fighting chronic illness as the approach that

offers the most promise.

78


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Sources

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80

partners

The following list includes members of the Partnership to Fight Chronic

Disease (PFCD) Advisory Board, as well as partner organizations and other

leaders of the PFCD.

Chairperson

Richard H. Carmona, M.D., M.P.H, FACS, 17th Surgeon General of the United

States (2002-2006), and President, Canyon Ranch Institute

Executive Director

Ken Thorpe, Ph.D., Professor and Chair of the Department of Health Policy and

Management at the Rollins School of Public Health at Emory University, is the Former

Deputy Assistant Secretary for the U.S. Department of Health and Human Services (HHS)

Advisory Board Members

Nelson L. Adams, M.D., President, National Medical Association

Peter B. Ajluni, D.O., President, American Osteopathic Association

Elena Alvarado, President, National Latina Health Network

Sharon Allison-Ottey, M.D., President, COSHAR Foundation

Paul Antony, M.D., Chief Medical Officer, Pharmaceutical Research and

Manufacturers of America

Alan Balch, Ph.D., Vice President, Preventive Health Partnership

Anna Burger, Secretary-Treasurer, SEIU; President, Change To Win

Jessica Donze Black, Executive Director, Campaign to End Obesity

Mark C. Blum, Executive Director, America’s Agenda: Health Care for All

Kenneth J. Bostock, Director, Legislative Policy & Analysis, National Asian Pacific

Center on Aging

Marc Boutin, Esq., Executive Vice President, National Health Council

Troyen Brennan, M.D., M.P.H., Senior Vice President and Chief Medical Officer,

Aetna Inc.

Senator John Breaux, Senior Counsel, Patton Boggs LLP

Richard J. Bringewatt, President, National Health Policy Group

Roslyn Brock, Vice Chairman, NAACP


Anthony Civello, Chairman, President and CEO of Kerr Drug, Inc., President of the

Board of Directors of the National Association of Chain Drug Stores

John M. Clymer, President, Partnership for Prevention

Robb Cohen, Chief Government Affairs Officer, XLHealth

Stephen C. Crane, Ph.D., M.P.H., Executive Vice President and CEO, American

Academy of Physician Assistants

Yanira Cruz, President and CEO, National Hispanic Council on Aging

Nancy Davenport-Ennis, National Patient Advocate Foundation

Judith S. Dempster, DNSc, FNP, FAANP, Executive Director, American Academy of

Nurse Practitioners

Thomas J. Donohue, President and CEO, U.S. Chamber of Commerce

William Ellis, R.Ph., M.S., Executive Director and CEO, American Pharmacists

Association Foundation

John Engler, President and CEO, National Association of Manufacturers


Mike Fitzpatrick, Executive Director, National Alliance on Mental Illness

Clayton S. Fong, President and CEO, National Asian Pacific Center on Aging

Christine Ferguson, J.D., Director, STOP Obesity Alliance

Alissa Fox, Vice President, Legislative and Regulatory Policy, Blue Cross Blue Shield

Association

Pat Ford-Roegner, M.S.W., R.N., F.A.A.N., CEO, American Academy of Nursing

Larry Gage, J.D., President, National Association of Public Hospitals and

Health Systems

Amy Garcia, RN, MSN, Executive Director, National Association of School Nurses

Judith Gilbride, Ph.D., R.D., C.D.N., F.A.D.A., President, American Dietetic Association

Eric Goplerud, Ph.D., Campaign Coordinator, Whole Health Campaign

Millicent Gorham, M.B.A., National Black Nurses Association

Eric J. Hall, CEO, Alzheimer’s Foundation of America

Bill Hoffman, Ph.D., Senior Consultant of Preventive Health, PILMA

Carolyn Hutcherson, M.S., R.N., Executive Director and CEO, American College of

Nurse Practitioners

Jed J. Jacobson, DDS, MS, MPH, Senior Vice President and Chief Science Officer

Delta Dental Plans of Michigan, Ohio, Indiana

Paul E. Jarris, M.D., M.B.A., Executive Director, Association of State and Territorial

Health Officials

Warren Jones, M.D., F.A.A.F.P., Executive Director, Mississippi Institute for

Improvement of Geographic Minority Health and Distinguished Professor of Health Policy

and Senior Health Policy Advisor at the University of Mississippi Medical Center

82

Rick Kellerman, M.D., F.A.A.F.P., President, American Academy of Family Physicians

J.D. Kleinke, Chairman and CEO, Omnimedix Institute

Mike Klowden, President and CEO, Milken Institute

Dan Leonard, President, National Pharmaceutical Council

Lucinda Maine, Ph.D., Executive Vice President and CEO, American Association of

Colleges of Pharmacy

Henri Manasse, Ph.D., Sc.D., Executive Vice President and CEO, American Society of

Health-System Pharmacists

William Marumoto, President and CEO, APAICS

Katie Maslow, Associate Director, Alzheimer’s Association

David McCarron, M.D., F.A.C.P., Managing Partner, Shaping America’s Youth

Merrill Matthews Jr., Ph.D., Director, Council for Affordable Health Insurance

Mark McClellan, M.D., Ph.D., Former Administrator of the Centers for Medicare and

Medicaid Services, U.S. Department of Health and Human Services, Senior Fellow and

Director, Engelberg Center for Health Care Reform, Economic Studies

Traci L. McClellan, Executive Director, National Indian Council on Aging

Eileen McGrath, J.D., Executive Vice President, American Society of Addiction Medicine

William McLin, Executive Director, Asthma and Allergy Foundation of America

Laurene T. McKillop, President, Sister to Sister

Suzanne Mintz, President and Co-Founder, National Family Caregivers Association

Larry Minnix, President and Chief Executive Officer, American Association of Homes

and Services for the Aging

Joe Moore, President and CEO, International Health Racquet, and

Sportsclub Association

Tracey Moorhead, President and CEO, DMAA: The Care Continuum Alliance

John B. Murphy, MD, President, American Geriatrics Society

Council Nedd, II, Executive Director, Alliance for Health Education and Development

Rita Needham, Executive Director, Southwest Area Manufacturers Association

Neil J. Nicoll, President and CEO, YMCA of the USA

Bill Novelli, Executive Director and CEO, AARP

Vincent Panvini, Legislative and Political Director, Sheet Metal Workers

International Association

Michael Parkinson, MD, MPH, FACPM, President, American College of

Preventive Medicine

Thomas Parry, Ph.D., President, Integrated Benefits Institute

Michel Paul, Worldwide Company Group Chairman, Johnson & Johnson Diabetes

Daniel Perry, Executive Director, Alliance for Aging Research

Elena Rios, M.D., President, National Hispanic Medical Association

Bruce Roberts, pharmacist, National Community Pharmacists Association

John Robitscher, MPH, Executive Director, National Association of Chronic

Disease Directors

Randall Rutta, Senior Vice President, Government Relations, Easter Seals

Tom Scanlon, former president of the National Coalition for Promoting Physical Activity

Wendy K.D. Selig, Vice president, External Affairs & Strategic Alliances, American

Cancer Society Cancer Action Network


Bill Sells, Director of Government Relations, Sporting Goods

Manufacturers Association

David L. Shern, Ph.D., President and CEO, Mental Health America

Victoria Shepard, Senior Vice President, Government Affairs, Healthways

Greg Simon, President, FasterCures

Katherine Clegg Smith, Ph.D., Assistant Professor, Department of Health, Behavior

and Society, Bloomberg School of Public Health, Johns Hopkins University

Rebecca Snead, pharmacist, Executive Vice President and CEO, National Alliance

of State Pharmacy Associations

Lidia Soto-Harmon, Deputy Executive Director, Girl Scout Council of the

Nation’s Capital

Billy Tauzin, President and CEO, Pharmaceutical Research and Manufacturers of

America

Lisa M. Tate, CEO, WomenHeart

John Thorner, Executive Director, National Recreation and Park Association

Neil Trautwein, J.D., Vice President and Employee Benefits Policy Counsel, National

Retail Federation

Stephen J. Ubl, President and CEO, AdvaMed

Rich Umbdenstock, President, American Hospital Association

Gretchen Clark Wartman, Vice President, Policy and Program, National Minority

Quality Forum

Andrew Webber, President & CEO, National Business Coalition on Health

Randall E. Williams, MD, FACC, Chief Executive Officer, Pharos Innovations

Daniel R. Wilson, Executive Director of Policy and Program Development,

National Caucus and Center on Black Aged

Cary Wing, Ed.D., Executive Director, Medical Fitness Association

Partner Organizations

AARP

Advanced Medical Technology Association (AdvaMed)

Aetna, Inc.

Alliance for Aging Research

Alliance for Health Education and Development (AHEAD)

Alliance for Patient Access

Alzheimer’s Association

Alzheimer’s Foundation of America

America’s Agenda: Health Care for All

American Academy of Family Physicians

American Academy of Nurse Practitioners

American Academy of Nursing

American Academy of Physician Assistants

American Association of Colleges of Nursing

American Association of Colleges of Pharmacy

American Association of Diabetes Educators

American Association of Homes and Services for the Aging

American Cancer Society Cancer Action Network

American College of Emergency Physicians

American College of Nurse Practitioners

American College of Preventive Medicine

84

American Dental Education Association

American Dietetic Association

American Geriatrics Society

American Hospital Association

American Lung Association

American Medical Women’s Association

American Osteopathic Association

American Pharmacists Association Foundation

American Society of Addiction Medicine

American Society of Health-System Pharmacists

APAICS

Arthritis Fuunation

Association of Maternal and Child Health Programs

Association of State and Territorial Health Officials

Asthma and Allergy Foundation of America

Biotechnology Industry Organization (BIO)

Blue Cross Blue Shield Association

Campaign to End Obesity

Canyon Ranch Institute

Cleveland Clinic

Community Health Charities

COPD Foundation

The COSHAR Foundation

Council for Affordable Health Insurance

Delta Dental

dLife

DMAA: The Care Continuum Alliance

DrTango

Discovery Health

Easter Seals

Eli Lilly

Epilepsy Foundation

FasterCures

Girl Scout Council of the Nation’s Capital

Healthcare Leadership Council

Healthways

Integrated Benefits Institute

Interamerican College of Physicians and Surgeons

International Association of Fire Fighters

International Health, Racquet & Sportsclub Association

Johnson & Johnson

Kerr Drug, Inc.

Lance Armstrong Foundation

League of United Latin American Citizens (LULAC)

The Leapfrog Group

Lupus Foundation of America

Marshfield Clinic

Medical Fitness Association

Men’s Health Network

Mental Health America

Milken Institute

Mississippi Institute for Improvement of Geographic Minority Health

NAACP

National Alliance for Caregiving


National Alliance of State Pharmacy Associations

National Alliance on Mental Illness

National Asian Pacific Center on Aging

National Association of Chronic Disease Directors

National Association of Community Health Centers

National Association of Manufacturers

National Association of Public Hospitals and Health Systems

National Association of School Nurses

National Association of VA Physicians and Dentists

National Black Nurses Association

National Business Coalition on Health

National Caucus and Center on Black Aged

National Coalition for Promoting Physical Activity

National Community Pharmacists Association

National Council for Community Behavioral Healthcare

National Family Caregivers Association

National Health Council

National Health Policy Group / Special Needs Plan Alliance

National Hispanic Council on Aging

National Hispanic Medical Association

National Indian Council on Aging

National Kidney Foundation

National Latina Health Network

National Medical Association

National Multiple Sclerosis Society

National Minority Quality Forum

National Patient Advocate Foundation

National Pharmaceutical Council

National Recreation and Park Association

National Retail Federation

Ohio State University Managed Health Care Systems, Inc.

Ovarian Cancer National Alliance

Partnership for Prevention

Pharmaceutical Research and Manufacturers of America (PhRMA)

Pharos Innovations

PILMA

Prevent Blindness America

RetireSafe

Self Chec

Service Employees International Union (SEIU)

Shaping America’s Youth

Sister to Sister

Sheet Metal Workers International Association

Southwest Area Manufacturers Association

Sporting Goods Manufacturers Association

STOP Obesity Alliance

UnitedHealth Group

U.S. Chamber of Commerce

Vision Council of America

Whole Health Campaign

WomenHeart

XLHealth

YMCA of the USA

about PFCD

About The Partnership to Fight Chronic Disease

86

The Partnership to Fight Chronic Disease (PFCD) is a national coalition of

patients, providers, community organizations, business and labor groups

and health policy experts committed to raising awareness of the number one

cause of death, disability, and rising health care costs in the United States:

chronic disease.

The PFCD’s mission is to:

! Challenge policymakers to make the issue of chronic disease a top priority

and articulate how they will address the issue through their health care

proposals! Educate the public about chronic disease and potential solutions for

individuals, communities, and the nation ! Mobilize Americans to call for change in how policymakers, governments,

employers, health institutions, and other entities approach chronic disease

For more information about the PFCD and its partner organizations,

please visit: www.fightchronicdisease.org

The Partnership to Fight Chronic Disease would like to thank the following PFCD staff members, and PFCD partner colleagues, for their work on this publication:

Lead authors

Anne Kott

Deirdre Fruh, M.P.A.

Research contributors

Lauren Cameron

Christine Greger

Katherine Klein

Carolyn Lethert, U.S. Workplace Wellness Alliance & U.S. Chamber of Commerce

Graphic Design

Darin Ruchirek

The PFCD also sincerely thanks the following people for their review of, and feedback on, the 2009 Almanac of Chronic Disease:

Candace DeMatteis, PFCD Policy Director

Kristina Hansen Lowell, Ph.D., Research Director, Engelberg Center for Health Care Reform, The Brookings Institution

Lydia L. Ogden, M.A., M.P.P, Chief of Staff, Institute for Advanced Policy Solutions, Emory University


Jennifer Cosenza, Canyon Ranch Institute

For more information about the Partnership to Fight Chronic Disease, please visit

www.fightchronicdisease.org

The Care Continuu

m Alliance

2009 almanac of chronic disease

Documents