Q2 — 2017 :
Chapter 03
Best Cities, Lifelong Wellness, and Productive Retirement
America’s Health Care Depends On Preventing Chronic Disease
Linda Fried
March 08, 2017

The United States is in the midst of another divisive fight about how health care is delivered to Americans from coast to coast. But no matter what mechanism evolves, its sustainability will depend on our nation’s success in preventing chronic disease—a goal that’s in everyone’s interest and represents an opportunity to work across party lines. A major commitment to combating chronic disease could build national unity while simultaneously reducing the rising costs of health care.

America faces an alarming increase in chronic diseases – especially due to obesity – including heart disease, stroke, type 2 diabetes, and some cancers. Though preventable, they threaten to overwhelm our health care system. As of 2012, about half of all adult Americans had one or more chronic health conditions, according to the Centers for Disease Control and Prevention (CDC), and one in four adults had two or more. Eighty-six percent of all health care spending covers people with chronic medical conditions, while the direct medical costs for chronic diseases and conditions exceed $750 billion annually.

Half of these chronic diseases could be preventable, at least. The return on investment from preventing these conditions is high. The Milken Institute has analyzed the rates of disease, treatment costs, and lost economic output attributable to seven major chronic diseases. Based on current trends, it projects that by 2023, chronic disease cases will increase by 42 percent, to 230 million, costing $4.2 trillion in treatment and lost economic output.

Personal behavior is vital to health, but willpower alone is not the answer. It cannot provide, for instance, safe places to exercise, clean air, safe water, or access to healthy food – the mom-and-apple pie approaches to preventing these diseases. What we need is a road map for preventing chronic disease that the entire nation can get behind – with the three-part goal of improving the well-being of all Americans, avoiding unnecessary costs and suffering, and building on existing initiatives and infrastructure. Who wouldn’t support that?

The road map should include the following four components:

First, the “Cancer Moonshot” initiative should be aggressively implemented. With the 21st Century Cures Act – a law that was overwhelming approved by both parties in the House and Senate – the Moonshot has $1.8 billion to fund its efforts to fight cancer. This could include preventing cancer in the first place. Its success could inspire a national consensus around future commitments to tackle other diseases.

Second, America’s infrastructure should be rebuilt with a focus on improving health as well as access and competitiveness. Bipartisan support for infrastructure investments is strong in Congress, but what is too often missing in the discussion is recognition of infrastructure’s role in our health.

Infrastructure is bigger than roads and bridges: it lays the ground work for healthier communities. In many communities, that translates to investing in new pipes for cleaner water, ensuring we can safely breath the air, or providing other basic needs. A strong infrastructure can also influence individual behaviors: sidewalks and bike lanes are important to encouraging exercise and public transit is key to promoting healthier forms of transportation. Access to needed services makes aging in place possible.

Infrastructure improvements can also be designed to increase public health at no additional cost to the public – and likely savings – for several reasons: much of the cost of poor health is borne by Medicare and Medicaid, so the federal government will benefit financially from improving health; infrastructure improvements are typically one-time expenses, while the benefits to public health are recurring; and, savings can be generated through greater efficiency.

Third, “precision public health” should address the health care needs of entire communities. Population health should be the goal, and certain populations require more precise interventions. One example, based on geography, is the recent outbreak of Zika virus in Miami and the subsequent spraying protocol. Another example, based on personal characteristics and geography, is the prevalence of obesity. Four states have adult obesity rates exceeding 35 percent, according to the State of Obesity, and strategies can be developed to combat those rates.

Precision public health provides new opportunities to use data to more effectively target health solutions to those who need them. Dr. Muin J. Khoury, director of the CDC’s Office of Public Health Genomics, predicts that innovative opportunities for precision public health “will result from specific advances in biomedical and public health sciences to target disease prevention to subsets of the population at high risk … Surveillance will benefit greatly from the availability of new data sources such as electronic health records and communication methods such as mobile technologies to track health behaviors, environmental hazards and disease outcomes.”

Fourth, aging well must become a national priority. More than 46.2 million Americans were 65 years or older in 2014, and by 2060, there will be about 98 million at that age, according to the Department of Health & Human Services. The question is: Will our longer lives be lived healthier? That will require investing in the approaches already mentioned, plus investing in healthy aging—starting with the health of our kids.

Early signs are encouraging. A U.S. government report, “Older Americans 2016: Key Indicators of Well-Being,” reveals that “Between 1999 and 2014, age-adjusted death rates for all causes of death among people age 65 and over declined by 20 percent. Death rates declined for heart disease, cancer, chronic lower respiratory disease, stroke, diabetes, and influenza and pneumonia. Death rates for Alzheimer’s disease and unintentional injuries increased over the same period.” That shows that these diseases do not have to be inevitable with increasing age.

Yet reducing death rates is not enough: we must keep older Americans healthy as long as possible. Fortunately, there are ways of building health through continued meaningful actions as people age.

Age-friendly cities and environments will be key, and initiatives can be designed that benefit multiple age groups simultaneously. An example is the recent data that people are likelier to live longer if the air that they have breathed is not polluted. Further, we know now that air pollution increases risk of memory loss in aging. The right infrastructure can prevent this.

It’s crucial that America accept the challenge of preventing chronic diseases and conditions and building health for longer lives. The cost of not doing so is simply too great.

The challenge may also provide one way to bring our nation together. It’s time to get out a national road map to combat chronic disease and start us all moving in the same direction.

Q2 — 2017 : Chapter 03 > America’s Health Care Depends On Preventing Chronic Disease by Linda Fried