1. Chronic Disease A Public Health Perspective Ronald Fischbach, Ph.D.

2. Chronic Disease Overview The most prevalent, costly, and preventable chronic diseases –cardiovascular disease (primarily heart disease and stroke), –cancer, and –diabetes

3. Leading Causes of Death in the U.S., 2003

4. Costs of Chronic Disease, U.S. In 2005, 133 million people, almost half of all Americans lived with at least one chronic condition The medical care costs of people with chronic diseases account for more than 75% of the nation’s $2 trillion medical care costs. $17,239 expenditure per household Chronic diseases account for one-third of the years of potential life lost before age 65. Hospitalizations for pregnancy-related complications occurring before delivery account for more than $1 billion annually. The direct and indirect costs of diabetes is $174 billion a year.

5. Costs of Chronic Disease, U.S. (Continued) Each year, arthritis results in estimated medical care costs of nearly $81 billion, and estimated total costs (medical care and lost productivity) of $128 billion. The estimated direct and indirect costs associated with smoking exceed $193 billion annually. In 2008, the cost of heart disease and stroke in the U.S. is projected to be $448 billion. The estimated total costs of obesity was nearly $117 billion in 2000. Cancer costs the nation an estimated $89 billion annually in direct medical costs. Nearly $98.6 billion is spent on dental services each year.

6. Cost-Effectiveness of Prevention Water fluoridation Smoking cessation Safer Choice Program (a school-based HIV, other STD, and pregnancy prevention program), Preconception care Arthritis Self-Help Course Breast cancer

7. CDC's Chronic Disease Programs CDC supports a variety of programs to improve the nation's health by preventing chronic diseases and their risk factors. These programs provide national leadership Sample CDS Program Arthritis Cancer Control Diabetes Healthy Aging Healthy Youth Heart Disease and Stroke Nutrition, Physical Activity and Obesity Safe Motherhood Tobacco

8. Targeting Arthritis Improving Quality of Life for More Than 46 Million Americans The Nation’s Most Common Cause of Disability Arthritis comprises over 100 different diseases and conditions Common symptoms

9. Why Is Arthritis a Public Health Problem? An estimated 46 million U.S. adults (about 1 in 5) reported doctor-diagnosed arthritis Nearly 19 million U.S. adults reported activity limitations because of arthritis Work limitations attributable to arthritis affect about 1 in 20 adults Arthritis results in 750,000 hospitalizations and 36 million outpatient visits 128 billion dollars in annual costs Arthritis is responsible for 9,500 deaths in the U.S. annually

10. What Can Be Done to Target Arthritis? Self-management education programs Chronic Disease Self-Management Program Physical activity Weight control and injury prevention Early diagnosis and appropriate management

11. What Are CDC and Its Partners Doing About Arthritis? CDC is committed to leading strategic public health efforts to promote well-being, prevent chronic disease, and achieve health equity. For example, the National Arthritis Action Plan

12. What Activities Does CDC’s Arthritis Program Support? The primary goal is to improve the quality of life for people affected by arthritis. The program achieves this goal by supporting the following five key activities: –Building state programs –Reaching the Public –Improving the science base –Measuring the burden of arthritis –Making policy and systems changes

13. Future Directions for the CDC Improve the quality of life for people affected by arthritis Move state programs from building capacity to implementing programs on a wider scale Identify model dissemination efforts Develop innovative interventions that meet the needs of diverse populations Work collaboratively with other chronic disease programs at federal and state levels

14. CDC Funding for State Arthritis Programs, 2008

15. Chronic Disease Indicators Ninety indicators that allows states and territories to uniformly define, collect, and report chronic disease data Seven categories: –Physical activity and nutrition –Tobacco and alcohol use –Cancer –Cardiovascular disease –Diabetes –Overarching conditions –Other diseases and risk factors

16. Tobacco Use The definition for each indicator includes a hyperlink to additional information and data resources. These include— Behavioral Risk Factor Surveillance System (BRFSS) Alcohol and Public Health Youth Risk Behavioral Surveillance System (YRBSS) State Tobacco Activities Tracking and Evaluation (STATE) System National Program of Cancer Registries State Cancer Profiles CDC WONDER Health-Related Quality of Life United States Renal Data System (USRDS)*United States Renal Data System (USRDS) Current Population Survey, American Community Survey National Diabetes Surveillance System National Oral Health Surveillance System

17. Tobacco Use: Behavioral Risk Factor Surveillance System (YRBSS)

18. Tobacco Use: Behavioral Risk Factor Surveillance System (YRBSS)- California

21. Tobacco Use: Behavioral Risk Factor Surveillance System (YRBSS)- California by Income

22. Tobacco Use: Behavioral Risk Factor Surveillance System (YRBSS)- California by Race

23. Tobacco Use: Behavioral Risk Factor Surveillance System (YRBSS)- California by Education

24. Tobacco Use: Behavioral Risk Factor Surveillance System (YRBSS)- California by Gender

25. Current California Adults

26. Current California Adults Grouped by Income

27. What You Can Do http://apps.nccd.cdc.gov/brfss/page.asp?cat=TU&yr=200 7&state=CA#TU

28. What You Can Do (Continued) Choose one of the other chronic diseases Click on the choice Explore the links and identify a possible public health intervention issue and target population

29. Review Questions (Developed by the Supercourse team) What is the role of CDC in the prevention of non-communicable diseases? Arthritis is a serious chronic disease, do you feel that it is receiving sufficient attention? What more can be done to reduce smoking in the US?