Chronic disease . . . the public health challenge of the 21st century
National Center for Chronic Disease Prevention and Health Promotion
The Power of PrevenTion
ChroniC disease . . . the publiC health Challenge of the 21st Century
The United States spends significantly more on health care than any other nation. In 2006, our health care expenditure was over $7,000 per person, more than twice the average of 29 other developed countries.2 We also have one of the fastest growth rates in health spending, tripling our expenditures since 1990. Yet the average life expectancy in the United States is far below many other nations that spend less on health care each year.
As a nation, more than 75% of our health care spending is on people with chronic conditions.3
These persistent conditions—the nation’s leading causes of death and disability—leave in their wake deaths that could have been prevented, lifelong disability, compromised quality of life, and burgeoning health care costs. The facts are arresting:
• 7 out of 10 deaths among Americans each year
are from chronic diseases.4
• In 2005, 133 million Americans—almost 1
out of every 2 adults—had at least one chronic
illness.5 • About one-fourth of people with chronic
conditions have one or more daily activity
• Health disparities in chronic disease incidence
and mortality are widespread among members
of racial and ethnic minority populations. For
example, heart disease death rates are higher
among African Americans than whites,4 and
diabetes rates are substantially higher among
American Indians and Alaska Natives than
whites.6 • Mental illnesses and chronic diseases are
closely related. Chronic diseases can exacerbate
symptoms of depression, and depressive
disorders can themselves lead to chronic diseases.7 The scope and severity of the chronic disease problem has not escaped the public’s attention.
More than two-thirds of all adults believe that the U.S. health care system should place more emphasis on chronic disease preventive care, and more than 4 in 5 Americans (84%) favor public funding for such prevention programs.8
whaT are These chronic condiTions?
Tackling chronic disease requires a closer look at the major conditions that affect our nation— namely, heart disease and stroke, cancer, diabetes, arthritis, obesity, respiratory diseases, and oral conditions. Heart disease and stroke
The good news is that since 1999, death rates for coronary heart disease and stroke have declined
20.8% and 24.4%, respectively.4 In addition, the percentage of adults with high cholesterol, a major risk factor for heart disease, has been cut by almost half since the early 1960s.6
YET . . .
• Heart disease and stroke remain the first and third leading causes of death, accounting for more than 30% of all mortality,4 and are among the leading causes of disability.9
• 1 million Americans are disabled from strokes; many can no longer perform daily tasks, such as walking or bathing, without help.9
• In 2003, approximately 37% of adults reported having two or more of the major risk factors for heart disease and stroke (high blood pressure, high cholesterol, diabetes, current smoking, physical inactivity, and obesity).10
• Many disparities persist—for example, age-adjusted stroke death rates for 2005 were 31% higher for African Americans than for whites, and heart disease death rates were 23% higher.4 Cancer
During the past two decades, tremendous progress has been made in developing and using effective cancer prevention strategies, early detection interventions, and cancer treatments. Largely through public health efforts targeting screening, breast cancer deaths among women decreased by 2% per year from 1998 to 2005, and deaths from colorectal cancer decreased among both men and women by 4% per year from 1995 to 2005.
YET . . .
• Cancer continues to claim more than half a million lives each year and