Half of all adults in the US have at least one chronic condition, such as diabetes, heart disease or obesity, according to a report by the Centers for Disease Control and Prevention published in The Lancet.

The paper - part of a new series in the journal, 'The health of Americans' - says the proportion of adult Americans who have two or more of these conditions is more than a quarter.

The researchers from the Centers for Disease Control and Prevention (CDC) say the bulk of this morbidity could be prevented through the reduction of risk factors that fall within individuals' control:

  • Tobacco use
  • Poor diet
  • Physical inactivity
  • Excessive alcohol consumption
  • Poorly treated high blood pressure
  • High cholesterol.

Both poor diet and physical inactivity are strongly associated with obesity. The researchers say:

"Compared with comparable high-income countries, the US is less healthy in areas such as obesity, heart disease, diabetes, and chronic lung diseases."

The authors from the CDC add that "chronic diseases are the main causes of poor health, disability, and death, and account for most of health care expenditures" in the US.

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The CDC state that "chronic diseases are the main causes of poor health, disability, and death, and account for most of health care expenditures" in the US.

The list of risk factors above that are largely responsible for this weight of chronic disease in the country is a "short one" that can be "effectively addressed for individuals and populations."

For example, to achieve effective control of high blood pressure, the authors recommend team-based approaches that include physicians, pharmacists, nurses and allied health professionals.

It also recommends support for patients' own efforts to manage conditions by "providing self-management education and methods in structured lifestyle programs" that are linked to "supportive community environments."

The US is not alone with the problem of chronic disease, however - the paper points out that "with non-communicable conditions accounting for nearly two-thirds of deaths worldwide, the emergence of chronic diseases as the predominant challenge to global health is undisputed."

Nationwide and community action

The CDC suggests, and takes part in, some solutions to the problem that "require coordinated action:"

  1. Epidemiology and surveillance to monitor trends and track progress
  2. Policies and environments that promote health and support healthy behaviors
  3. Health care that effectively delivers prevention services
  4. Stronger links between health care and community services.

"Collectively, these four strategies will prevent the occurrence of chronic diseases, foster early detection and slow disease progression in people with chronic conditions, reduce complications, support an improved quality of life, and reduce demand on the health care system," the report concludes.

A key part of the prevention element is covered in another paper from 'The health of Americans' (reported by MNT - see Obamacare means 'better public health' through prevention). It claims the Patient Protection and Affordable Care Act will bring improvements to the nation's health, thanks to a greater emphasis on preventive medicine.

The current paper touches on Obamacare, too:

"As the US health care [system] undergoes further transformations with implementation of the Affordable Care Act, and as fiscal challenges continue, opportunities and needs to further improve the health status of Americans will become clearer."

"Of crucial importance," the CDC authors say, is that prevention and early-detection services become more effective if there is collaboration between the public health sector and health care providers. Also, by "solidifying collaborations between communities and health care providers," population health is improved and sustained.

"This collaborative approach," the authors conclude, "will improve health equity" by building communities that:

  • Promote health rather than disease
  • Have more accessible and direct care
  • Focus the health care system on improving population health.

The high burden of ill health in the US is attributable to "incidence and prevalence of leading chronic conditions and risk factors (which occur individually and in combination)" - but is also the result of population demographics, including health disparities and an aging population.

The report indicates that Medicare enrollees (most of whom are aged over 65) constitute 300 billion dollars in health care spending.

Over 90% of this health care spending was accounted for by people with two or more chronic conditions.