The Almanac of Chronic Disease

1
The Almanac of Chronic Disease
2008 Edition
2
Table of Contents

• The Human Cost Today
• The Economic Cost Today
• The Cost Tomorrow
• Opportunity for Improvement
• Understanding of the Problem and Support for
  Change

3
Chapter One The Human Cost Today

• Introduction
• Chronic diseases are a significant problem in
  the United States, accounting for many of the
  most prevalent and costly illnesses that affect
  Americans. More than 133 million Americans, or 45
  percent of the population, have at least one
  chronic condition. These conditions include
  arthritis, asthma, cancer, cardiovascular (heart)
  disease, depression and diabetes, though these
  are only a few of many chronic illnesses that
  negatively impact the lives of Americans.
• Many chronic diseases are caused or exacerbated
  by poor nutrition, lack of exercise, smoking and
  other lifestyle choices. As a result of these
  factors, as well as a lack of emphasis on
  preventive care, incidence rates of chronic
  disease have increased substantially over the
  last two decades. Risk factors like obesity are
  also on the rise. Since 1980, obesity rates have
  increased 250 percent, now affecting 71 million
  Americans. This has tremendous implications for
  future generations for example, it is predicted
  that 1 in 3 children born in 2000 will develop
  diabetes over the course of their lives, given
  current trends in overweight and obesity.
• 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. Minority populations
  are often disproportionately impacted by chronic
  disease, with African Americans and Hispanics
  often 1.5 to 2 times more likely to have a
  certain condition than their white counterparts.

4
Nearly half of Americans have one or more chronic
diseases
Total U.S. population
45 -- 133 million Americans have one or more
Source Wu S, Green A. Projection of Chronic
Illness Prevalence and Cost Inflation. RAND
Corporation, October 2000.
5
Many Americans have more than one chronic health
problem
Percent of all Americans with chronic health
conditions
Source Anderson, G. Chronic Conditions Making
the case for ongoing care. Johns Hopkins
University. November 2007.
6
Cardiovascular conditions are among the most
prevalent types of chronic health problems
Number (in millions) of Americans reporting
specific chronic conditions
Stroke Cancers Diabetes Heart disease Mental
disorders Hypertension Pulmonary conditions
Million
Source DeVol, R, Bedroussian, A, et al. An
Unhealthy America The Economic Burden of Chronic
Disease. The Milken Institute. October 2007. Full
report available at www.chronicdiseaseimpact.com.

7
Mental health conditions, such as depression,
dramatically increase disability when paired
with other chronic health conditions
Degree of disability due to select chronic
diseases plus depression

• Degree of disability due to select chronic
  diseases

Degree of disability
Diabetes
Arthritis
Angina
Asthma
Diabetes
Arthritis
Angina
Asthma
Disability is the measure of difficulty
completing important and ordinary life tasks and
roles.  
Source WHO World Health Survey, Moussavi, et al,
(2007) Lancet
8
Older adults are more likely to have a chronic
health condition, but Americans of all ages are
affected
Percent of population with chronic conditions
Ages
Source Anderson, G. Chronic Conditions Making
the case for ongoing care. Johns Hopkins
University. November 2007.
9
Certain chronic diseases, such as diabetes, are
more prevalent among minority populations
Percent within population with diabetes
Source American Diabetes Association. Total
Prevalence of Diabetes and Pre-diabetes. Accessed
at https//www.diabetes.org/diabetes-statistics/p
revalence.jsp
10
Many chronic diseases are on the rise in the U.S.
Percent of adult population diagnosed with
diabetes
Percent of adult population with diagnosed with
asthma
Source U.S. Centers for Disease Control
Prevention. Crude and Age-Adjusted Incidence of
Diagnosed Diabetes per 1000 Population Aged 18-79
Years, United States, 19802005. Accessed at
http//www.cdc.gov/diabetes/statistics/incidence/f
ig2.htm
Source U.S. Centers for Disease Control
Prevention. National Surveillance for Asthma ---
United States, 19802004. Accessed at
http//www.cdc.gov/mmwr/preview/mmwrhtml/ss5608a1.
htm
11
Many cases of chronic diseases go undiagnosed
Total with diabetes 18 million

• A survey conducted by the Centers for Disease
  Control and Prevention (CDC) found that nearly
  one third of people with diabetes dont know they
  have it

One-third of people with diabetes, or nearly 6
million people, dont know they have it
Centers for Disease Control and Prevention ,
Prevalence of Diabetes and Impaired Fasting
Glucose in Adults - United States, 1999-2000,
MMWR, 2003. Vol. 52(35), p. 833.
12
Other cases of chronic disease are diagnosed but
not well-controlled
Percent of Americans with hypertension
Source Presentation by David Cutler. Alliance
for Health Reform Novartis/NIHCM Briefing. March
28, 2008. Original sources NHANES
13
And in other cases, chronic disease factors are
starting to be better treated but still not very
successfully
Percent of U.S. adults with high cholesterol
1988-94 1999-2004
Please note that percentage is slightly more than
100 due to rounding
Source Presentation by David Cutler. Alliance
for Health Reform Novartis/NIHCM Briefing. March
28, 2008. Original sources NHANES
14
Rates of obesity -- one of the key risk factors
for a number of chronic health problems -- have
increased substantially
Percent of U.S. adults who are obese
1985
2005
Source Thorpe K, Florence, C, Howard, D, Joski,
P. The Impact of Obesity in Rising Medical
Spending. Health Affairs. 2004.
15
Childhood obesity and overweight have more than
doubled in the U.S. over the past two decades
Percent of children who are overweight
Source Centers for Disease Control and
Prevention. Childhood Overweight. Accessed at
http//www.cdc.gov/nccdphp/dnpa/obesity/childhood/
16
Childhood chronic diseases have more than
quadrupled over the past four decades and are
predicted to increase at an alarming rate
Percent of U.S. children with a chronic disease
Source Perrin, James M. Bloom, Sheila R.
Gortmaker, Steven L. The Increase of Childhood
Chronic Conditions in the United States. Journal
of the American Medical Association
17
The increase in childhood obesity is placing the
next generation at great risk for developing
chronic diseases earlier in life
1 in 3 children born in 2000 will develop
diabetes over the course of their lives, given
current trends
One third Portion of children who will develop
diabetes over their lifetime
Given current trends in childhood overweight and
obesity
Source Laino C. One in three kids will develop
diabetes. Web MD. June 16, 2003. Available
at http//www.webmd.com/content/article/66/79851.
htm. Accessed July 31 ,2006.
18
Many Americans are not getting enough physical
activity, a key factor for avoiding chronic
diseases and obesity
Percent of adults who do NOT get the recommended
amount of physical activity
Age
Source Centers for Disease Control and
Prevention. Prevalence of Regular Physical
Activity Among Adults --- United States, 2001 and
2005. Accessed at http//www.cdc.gov/mmwr/preview
/mmwrhtml/mm5646a1.htm?s_cidmm5646a1_e
19
Minority Americans are less likely to get enough
physical activity, which may contribute to higher
levels of chronic disease among these groups
Percent of adults who are NOT getting recommended
levels of exercise
Source Centers for Disease Control and
Prevention. Prevalence of Regular Physical
Activity Among Adults --- United States, 2001 and
2005. Accessed at http//www.cdc.gov/mmwr/preview
/mmwrhtml/mm5646a1.htm?s_cidmm5646a1_e
20
States in the South and New England have the
highest rates of chronic disease
States in the top quartile have the lowest rates
of seven common chronic diseases
Source DeVol, R, Bedroussian, A, et al. An
Unhealthy America The Economic Burden of Chronic
Disease. The Milken Institute. October 2007. Full
report available at www.chronicdiseaseimpact.com.

21
Chronic diseases are the leading cause of death
and disability in the U.S.
Chronic disease accounts for four of the top five
causes of death
Chronic disease is responsible for seven out of
every 10 deaths each year
Source Centers for Disease Control and
Prevention. Chronic Disease Overview page.
Available at http//www.cdc.gov/nccdphp/overview.
htm. Accessed April 6, 2007. Source Centers for
Disease Control and Prevention. Health, United
States, 2007. http//www.cdc.gov/nchs/data/hus/hus
07.pdfsummary
22
Family caregivers are a critical support
structure for Americans with chronic illnesses,
and the U.S. health care system

• In any given year, more than 50 million
  Americans find themselves in a caregiving role

Family caregivers provide the vast majority (80
percent) of all long-term care services for those
with a chronic illness or disability
Almost one in five (17 percent) family caregivers
provide 40 hours of care a week or more
Source Thompson L., Long-term care Support for
family caregivers Issue Brief. Washington, DC
Georgetown University, 2004 and U.S. Agency for
Healthcare Research and Quality. Long-Term Care
Financing Project, Long-term Care Users Range in
Age and Most Do Not Live in Nursing Homes.
November 8, 2000.
23
Caregiving can take a toll on caregivers' health
Children caring for aging parents suffer from
depression at twice the rate than noncaregivers,
and spousal caregivers suffer as much as six
times as high
Family caregivers experiencing extreme stress
have been shown to have weakened immune systems,
be more prone to chronic diseases themselves and
age prematurely. This level of stress can take
as much as 10 years off a family caregiver's life.
Source Cannuscio CC, Jones C, Kawachi I, Colditz
G.A., Berkman L and Rimm E, Reverberation of
family illness A longitudinal assessment of
informal caregiver and mental health status in
the nurses health study. American Journal of
Public Health. 92305-1311, 2002. Also, Glaser,
JK and Glaser, R. Chronic stress and age-related
increases in the proinflammatory cytokine IL-6.
Proceedings of the National Academy of Sciences,
June 30, 2003. Also, Epel ES, Dept of Psychiatry,
Univ. of California, San Francisco, et al, From
the Proceedings of the National Academy of
Science, Dec 7, 2004, Vol. 101, No. 49.
24
Chapter Two The Economic Cost Today

• Introduction
• Chronic diseases are at the root of a
  significant portion of rising health care costs.
  About two-thirds of the rise in health care
  spending over the last two decades is due to the
  rise in treated rates of chronic disease. In
  addition, the vast majority of current spending
  is for treatment of Americans with one or more
  chronic conditions. Indeed, more than 75 percent
  of the approximately 2 trillion Americans spend
  each year on health care is spent on chronic
  diseases, and public health programs like
  Medicare and Medicaid are seeing sizable portions
  of their budget devoted to treatment of chronic
  diseases and complications from those conditions.
  
• But direct health care costs represent only a
  quarter of the total cost of chronic diseases.
  Indirect costs such as absenteeism and
  presenteeism cost businesses and our economy
  -- 1 trillion a year. Every year, millions of
  work days are missed because employees are
  suffering themselves from a chronic disease, or
  they have to care for a loved one who is ill.
• Presenteeism is defined as lost productivity
  that occurs when employees come to work but
  perform below par due to any kind of illness.

25
Three in four dollars spent on health care in the
U.S. are for patients with one or more chronic
conditions
Total U.S. health spending in 2006 2.1 trillion
Health care costs associated with patients with
one or more chronic diseases 1.58 trillion
Source Centers for Disease Control and
Prevention. Chronic Disease Overview page.
Available at http//www.cdc.gov/nccdphp/overview.
htm. Accessed April 6, 2007.
26
In public health problems, patients with chronic
diseases represent an even higher percentage of
spending
More than 96 cents of every dollar spent in
Medicare
and 83 cents of every dollar spent in Medicaid
96 percent of Medicare spending is on patients
with chronic diseases
83 percent of Medicaid spending is on patients
with chronic diseases
Source Partnership for Solutions. Chronic
Conditions Making the Case for Ongoing Care.
September 2004 Update. Available at
http//www.rwjf.org/files/research/Chronic20Condi
tions20Chartbook209-2004.ppt. Accessed on April
17, 2007.
27
Not surprisingly, people with chronic conditions
are the heaviest users of health care services
Percent of services used by people with chronic
conditions
Source Anderson, G. Chronic Conditions Making
the case for ongoing care. Johns Hopkins
University. November 2007.
28
Increases in the prevalence and treatment
intensity of chronic disease are responsible for
about two-thirds of the increase in health care
costs over the past two decades
Source Thorpe K. The Rise In Health Care
Spending And What To Do About It. Health Affairs.
200561436-1445. Also, Thorpe K, Florence CS,
Joski P. Which Medical Conditions Account For The
Rise In Health Care Spending?
29
The doubling of obesity is responsible for about
one-third of the rise in health care costs since
the mid-1980s
Percent of U.S. adults who are obese
1985
2005
BMI 30, or 30 lbs overweight for 5 4 person
Source Thorpe K, Florence, C, Howard, D, Joski,
P. The Impact of Obesity in Rising Medical
Spending. Health Affairs. 2004.
30
Health care spending related to chronic diseases
is dwarfed by the indirect costs of these health
problems
Total burden of disease in 2003 1.3 trillion
Direct costs represent about a fifth of the total
cost burden of chronic diseases
277 billion 21
Indirect costs amount to four-fifths of the total
burden
1.0 trillion 79
Direct costs Health care costs associated with
treatment of chronic disease
Indirect costs Productivity losses such as
absenteeism and presenteeism associated with
people with chronic diseases
Source DeVol, R, Bedroussian, A, et al . An
Unhealthy America The economic burden of chronic
disease. The Milken Institute. October 2007.
Note Statistics only include data for top seven
chronic diseases
31
Cancer and hypertension are among the most costly
chronic conditions, accounting for over 500
billion annually in treatment expenditures and
lost economic output
Treatment expenditures and lost economic output
(in billions) per chronic condition
Source DeVol, R, Bedroussian, A, et al. An
Unhealthy America The Economic Burden of Chronic
Disease. The Milken Institute. October 2007. Full
report available at www.chronicdiseaseimpact.com.
Note Statistics only include data for top seven
chronic diseases
32
Presenteeism is responsible for the largest share
of lost economic output associated with chronic
health problems
Cost of chronic diseases by category, 2003
Total 1 trillion
Presenteeism is defined as lost productivity that
occurs when employees come to work but perform
below par due to any kind of illness.
Source DeVol, R, Bedroussian, A, et al. An
Unhealthy America The Economic Burden of Chronic
Disease. The Milken Institute. October 2007. Full
report available at www.chronicdiseaseimpact.com.
Note Statistics only include data for top seven
chronic diseases
33
Depression and stress are the most common causes
of absenteeism
Number of days absent per affected individual per
year due to 10 conditions, 1997-1999
Depression/Sadness/Mental Illness
Any Cancer
Respiratory Disorders
Asthma
Migraine/Headache
Allergy
Heart Disease
Arthritis
Diabetes
Hypertension
Source Goetzel, R.Z., et al. (2004). Health,
Absence, Disability, and Presenteeism Cost
Estimates of Certain Physical and Mental Health
Conditions Affecting U.S. Employers. Journal of
Occupational and Environmental Medicine, 46(4),
398-412.Taken from American Hospital
Association. Trendwatch. Summer 2007. Accessed
at http//www.aha.org/aha/trendwatch/2007/twoct20
07health.ppt
34
When it comes to presenteeism, arthritis,
hypertension, and depression are among the most
costly conditions
Estimated average annual cost of presenteeism per
employee with condition
Source Goetzel, R.Z., et al. (2004). Health,
Absence, Disability, and Presenteeism Cost
Estimates of Certain Physical and Mental Health
Conditions Affecting U.S. Employers. Journal of
Occupational and Environmental Medicine, 46(4),
398-412. Taken from American Hospital
Association. Trendwatch. Summer 2007. Accessed
at http//www.aha.org/aha/trendwatch/2007/twoct20
07health.ppt
35
And mental illnesses, when comorbid with other
chronic diseases, significantly decrease work
productivity
Cormorbidity is the condition of having two or
more diseases at the same time.
All disability associated with arthritis is
attributable to comorbid mental illness.
Source Kessler, RC, Ormel, J, Demler, O, et al.
Comorbid Mental Disorders Account for the Role
Impairment of Commonly Occurring Chronic Physical
Disorders Results From the National Comorbidity
Survey.  Journal of Occupational Environmental
Medicine. 45(12)1257-1266, December 2003.
36
Caregiving costs workers and employers
Caregiving families tend to have incomes that are
15,000 less than noncaregiving families, yet
they spend 2.5 times more on out of pocket
medical expenses.
In 2000, working family caregivers lost 109 per
day in wages and health benefits due to the need
to provide full time care at home.

• Employers can lose as much as 33 billion each
  year due to employees' need

Source Disability and American Families 2000,
Census 2000 Special Reports, July 2005. and Drs.
Altman, Cooper and Cunningham, The Case of
Disability in the Family Impact on Health Care
Utilization and Expenditures for Non-disabled
Members, Milbank Quarterly 77 (1) pages 39 75,
1999. Also, Stucki BR and Mulvey J, Can Aging
Baby Boomers Avoid the Nursing Home? Long-term
Care Insurance for Aging in Place. American
Council of Life Insurers. March 2000. Also,
Metlife Mature Market Institute and National
Alliance for Caregiving, MetLife. Caregiving Cost
Study Productivity Losses to U.S. Business. July
2006.
37
Chapter Three The Cost Tomorrow

• Introduction
• While chronic diseases exact a huge toll on
  Americans today, the future is even more
  troubling. Over the next 15 years, the prevalence
  of chronic conditions in the U.S. is expected to
  rise dramatically. According to a study by the
  Milken Institute, there will be 230 million
  reported cases of chronic disease in 2023, an
  increase of 42 percent from 2003. Cases of
  cancer, diabetes and mental disorders are
  expected to rise most substantially, by 53 to 60
  percent per illness. In addition, the number of
  obese Americans, currently one third of the total
  population, is also projected to increase. By the
  year 2015, it is predicted that 75 percent of
  Americans will be obese, significantly
  contributing to the rise in chronic illnesses.
• Indeed, if current U.S. health trends continue,
  the results could be catastrophic for future
  generations, the health care system and the
  economy. Without immediate focus on prevention,
  the direct and indirect costs of chronic diseases
  are predicted to grow exponentially. Research has
  shown that, if left unchecked, chronic conditions
  will cost the U.S. economy over 4.1 trillion
  annually in treatment expenditures and lost
  economic output by the year 2023. Certain
  diseases, like heart disease and cancers, will be
  the most costly.

38
By the year 2023, the incidence of chronic
disease is expected to rise dramatically
Projected rise in cases of chronic disease,
2003-2023
Source DeVol, R, Bedroussian, A, et al. An
Unhealthy America The Economic Burden of Chronic
Disease. The Milken Institute. October 2007. Full
report available at www.chronicdiseaseimpact.com.
Note Statistics only include data for top seven
chronic diseases
39
The rate of obesity is also expected to increase,
and contribute to rising rates of chronic diseases
By 2015, it is predicted that 41 percent of
Americans will be obese
By 2015, researchers predict 75 percent of adults
and 24 percent of children will be overweight or
obese
1960
2004
2015
Source Wang, Y and Beydoun, M. The Obesity
Epidemic in the United StatesGender, Age,
Socioeconomic, Racial/Ethnic, and Geographic
Characteristics A Systematic Review and
Meta-Regression Analysis. Epidemiologic Review.
2007 29(1)6-28 doi10.1093/epirev/mxm007
40
If left unchecked, chronic diseases will cost our
economy over 4.1 trillion by the year 2023
Source DeVol, R, Bedroussian, A, et al. An
Unhealthy America The Economic Burden of Chronic
Disease. The Milken Institute. October 2007. Full
report available at www.chronicdiseaseimpact.com.
Note Statistics only include data for top seven
chronic diseases
41
And could cost the U.S. almost 6 trillion in
lost economic output by 2050
US Trillions
Source DeVol, R, Bedroussian, A, et al. An
Unhealthy America The Economic Burden of Chronic
Disease. The Milken Institute. October 2007. Full
report available at www.chronicdiseaseimpact.com.
Note Statistics only include data for top seven
chronic diseases
42
But simple changes in behaviors could lead to
significant decreases in cases of common and
costly chronic diseases

• The Centers for Disease Control and Prevention
  (CDC) estimates up to
• could be prevented if only Americans were to do
  three things
• Stop smoking
• Start eating healthy
• Get in shape

80 of heart disease and stroke
80 of type 2 diabetes
40 of cancer
Source Mensah G. Global and Domestic Health
Priorities Spotlight on Chronic Disease.
National Business Group on Health Webinar. May
23, 2006. Available at http//www.businessgrouphe
alth.org/opportunities/webinar052306chronicdisease
s.pdf. Accessed April 17, 2007.
43
Chapter Four Opportunity for Improvement

• Introduction
• Right now, far too little is being invested in
  improving Americans health and effectively
  preventing and managing common and costly chronic
  health problems. In an average year, the U.S.
  spends less than 10 per person on prevention --
  about the same amount of money as a single movie
  ticket costs in many places in the U.S.!
• Improvements in personal health behaviors,
  investment by business and the health care system
  in population health improvement could save
  millions of lives, and trillions of dollars. By
  the year 2023, the U.S. could save over 1
  trillion through investing in prevention, mostly
  by reducing indirect costs of chronic health
  problems, such as absenteeism and presenteeism.

44
Each year, the U.S. spends less than 5 percent of
its over 2 trillion health care budget on
prevention
5 percent of our health care budget is spent on
prevention
75 percent of our health care budget is spent on
chronic diseases
Source?
45
Increasing the use of common preventive care
services could save 100,000 lives each year in
the United States alone
According to the Partnership for Prevention,
increasing the use of just 5 preventive services
to 90 percent from their current rates would save
more than 100,000 lives each year in the U.S.
Target rate for use of service
Source Partnership for Prevention. Preventive
Care A National Profile on Use, Disparities, and
Health Benefits. August 2007. Accessed at
http//www.prevent.org/content/view/129/72
46
There is also substantial room for improvement in
treating chronically ill patients to prevent
further complications
Only half receive appropriate preventive care
Chronically ill patients receive only 56 of the
clinically recommended preventive health care
services
Source McGlynn EA, Asch SM, Adams J, et al. The
quality of health care delivered to adults in the
United States. New England Journal of Medicine
20033482635-264.
47
Many people with serious chronic diseases feel
they do not receive adequate care for their
conditions
Percent of people with serious chronic conditions
who believe they do NOT receive needed treatment
Distribution by select group
Source Anderson, G. Chronic Conditions Making
the case for ongoing care. Johns Hopkins
University. November 2007.
48
Patients with chronic illness often see multiple
health care providers, and this can make
coordination of care complicated
Number of different physicians seen by people
with serious chronic conditions
Source Anderson, G. Chronic Conditions Making
the case for ongoing care. Johns Hopkins
University. November 2007.
49
Conflicting or confusing information can be a
serious problem for Americans with chronic
diseases
Percent of Americans with chronic health problems
reporting that they
Source Anderson, G. Chronic Conditions Making
the case for ongoing care. Johns Hopkins
University. November 2007.
50
Non-white Americans often receive a different
level of treatment for their chronic conditions
Source Anderson, G. Chronic Conditions Making
the case for ongoing care. Johns Hopkins
University. November 2007.
51
Physicians believe patients with chronic
conditions often have problems accessing care
Percent of physicians who believe access is
difficult or very difficult in the following
areas of care for people with chronic conditions
Source Anderson, G. Chronic Conditions Making
the case for ongoing care. Johns Hopkins
University. November 2007.
52
Workplace health promotion programs have been
shown to reduce health care costs, increase
productivity and reduce absenteeism
Average percent change in employers costs
resulting from workplace health promotion and
wellness programs
Workers comp./ disability management claims
costs
Health costs
Absenteeism
Source Chapman, L. (2003). Meta-evaluation of
Worksite Health Promotion Economic Return
Studies. Art of Health Promotion Newsletter,
6(6).Taken from American Hospital Association.
Trendwatch. Summer 2007. Accessed at
http//www.aha.org/aha/trendwatch/2007/twoct2007he
alth.ppt
53
By the year 2023, the U.S. can save over 1
trillion through investing in prevention, mostly
in indirect costs
Lost economic output (indirect)
Treatment expenditures (direct)
Source DeVol, R, Bedroussian, A, et al. An
Unhealthy America The Economic Burden of Chronic
Disease. The Milken Institute. October 2007. Full
report available at www.chronicdiseaseimpact.com.
Note Statistics only include data for top seven
chronic diseases
54
Investing in prevention will save the U.S.
billions of dollars in direct and indirect health
costs
Costs of chronic disease (in billions) in 2023
due to treatment expenditures and lost economic
output
Source DeVol, R, Bedroussian, A, et al. An
Unhealthy America The Economic Burden of Chronic
Disease. The Milken Institute. October 2007. Full
report available at www.chronicdiseaseimpact.com.
Note Statistics only include data for top seven
chronic diseases
55
Chapter Five Understanding of the Problem and
Support for Change

• Introduction
• As Americans look to choose their next
  president, health care is the domestic issue they
  want to hear candidates discuss. While many
  Americans are interested in hearing about how
  candidates plan to improve access to care and
  cover the uninsured, in particular, they want to
  know what the next president will do to make
  health care more affordable. Perhaps this is not
  surprising given the fact that surveys have shown
  that Americans are very concerned about increases
  in health insurance premiums and the amount they
  will pay in out-of-pocket health care expenses.
• Despite the significant role that chronic
  diseases play in contributing to health care
  spending and deaths in the U.S., many Americans
  do not understand the extent or scope of the
  problem. Still, they recognize that something
  must be done to address the unchecked rise in
  chronic disease, and the vast majority suggest
  that this is an issue they want the next
  president to address.
• Americans believe that access to care is an
  important factor that must be considered when
  addressing how to reduce problems with chronic
  disease. They strongly support increasing the
  share of health care dollars devoted to
  prevention and endorse policies that change the
  focus of health care to promoting health and
  wellness, instead of just treating illness after
  it occurs.

56
In 2008, health care is the top domestic issue
that the public wants to hear presidential
candidates talk about
Percent saying that they want candidates to talk
about
Source Kaiser Family Foundation. Kaiser Health
Tracking Poll Election 2008 - December 2007.
Accessed at http//www.kff.org/kaiserpolls/h08_po
mr122007pkg.cfm
57
When it comes to health care, Americans say they
want the candidates to talk about how to reduce
costs
Percent who reported that they want to hear
candidates talk about
Source Kaiser Family Foundation. Kaiser Health
Tracking Poll Election 2008 - December 2007.
Accessed at http//www.kff.org/kaiserpolls/h08_po
mr122007pkg.cfm
58
Most Americans dont understand how significantly
chronic illnesses contributes to health care
spending and deaths in the U.S.
Only about 1 in 10 make an accurate estimate
Survey by the Partnership to Fight Chronic
Disease Conducted by APCO Insight, April 27-29,
2007 and based on telephone interviews with a
national adult sample of 1,001.
59
Still, Americans recognize chronic diseases are a
problem and say they want candidates to have a
plan to address it
How important is it for the 2008 presidential
candidates to have a plan to reduce chronic
diseases?
Survey by the Partnership to Fight Chronic
Disease Conducted by APCO Insight, April 27-29,
2007 and based on telephone interviews with a
national adult sample of 1,001.
60
Many Americans believe that access to care is a
problem for people with chronic diseases
Percent who believe that the following factor is
a problem
Source Anderson, G. Chronic Conditions Making
the case for ongoing care. Johns Hopkins
University. November 2007.
61
and that the U.S. should invest more in
prevention
Four out of five Americans prefer health care
dollars to be spent on preventive measures as
opposed to treating diseases after the fact.
81 percent of adults interviewed believe the U.S.
should prioritize our health care dollars to
invest in preventive measures
Survey by the Partnership to Fight Chronic
Disease Conducted by APCO Insight, April 27-29,
2007 and based on telephone interviews with a
national adult sample of 1,001.
62
Resources

• PFCD Resources
• PFCD Policy Platform http//www.fightchronicdisea
  se.com/advocate/platform/index.cfm
• PFCD Unhealthy Truth Presentation
  http//www.fightchronicdisease.com/resources/natio
  nal.cfm
• Chronic Care Chartbook
• http//www.fightchronicdisease.com/crisis/index.c
  fm
• Partner Resources
• Alliance for Aging Research Silver Book
  http//www.silverbook.org/
• American Cancer Society Cancer Facts Figures
  2007http//www.cancer.org/docroot/STT/content/st
  t_1x_cancer_facts__figures_2007.asp
• American Hospital Association Trendwatch Reports
  http//www.aha.org/aha_app/trendwatch/archive.jsp
  
• Milken Institute An Unhealthy America Report
  http//www.chronicdiseaseimpact.com/
• Partnership for Prevention