VII. Chronic Disease Prevention

FY 2000 Performance Plan - Revised Final FY 1999 Performance Plan

• Heart Disease and Health Promotion
• Breast and Cervical Cancer Prevention
• Cancer Registries
• Diabetes and Other Chronic Conditions

The United States cannot effectively address escalating health care costs without addressing the prevention of chronic diseases for the following reasons:

• More than 90 million Americans live with chronic illnesses.
• Chronic diseases account for 70 percent of all U.S. deaths.
• 61 percent of the $655 billion total cost of health and medical care in 1990 was attributable to chronic diseases.
• Chronic diseases account for one-third of the years of potential life lost before age 65.

The increase in the proportion of older Americans, largely due to the aging of the baby boom generation, means that an effective public health response to chronic and disabling conditions must be developed now. Cancer will strike more than 1.3 million Americans this year. More than 40% of all deaths in the United States each year are directly attributable to heart disease and stroke. The impact of conditions such as arthritis, osteoporosis, Alzheimer's disease, and urinary incontinence on our society is considerable and will grow as our population ages. These and other conditions result in disability and decreased quality of life for millions of Americans.

Prevention of the occurrence and progression of chronic disease is based on reducing or eliminating behavioral risk factors, increasing the prevalence of health promotion practices, and detecting disease early to avoid complications. Prevention programs have been shown to be effective. For example, for every dollar spent on school health programs addressing tobacco, drug and alcohol and sexuality education, fourteen dollars are saved in avoided health care costs. Almost all deaths from cervical cancer and an estimated 30 percent of deaths from breast cancer in women over age 50 are preventable through widespread use of screening mammography and Papanicolau (Pap) testing.

When developing performance measures for chronic disease prevention programs, several factors tempered our consideration. These factors included:

• The long latency of chronic diseases.
  • Chronic diseases include the three leading causes of death in the United States--heart disease, cancer, and cerebrovascular--which account for nearly two thirds of all deaths. Multiple behavioral risk factors such as smoking, poor diet, and lack of exercise often become habitual during youth or early adulthood and contribute to the development of these chronic diseases over long periods of time.
  • Health outcome measures are particularly problematic for chronic disease prevention programs because of the long latency period of many chronic diseases. For instance, reductions in smoking rates will not produce reductions in lung cancer deaths for decades. Further, behavior change itself is adopted slowly. Many of the most effective interventions are aimed at preventing youth from adopting risky behaviors, while the positive outcomes associated with these interventions are not reaped until adulthood. Over time, Americans can be influenced to adopt healthier behaviors, but such progress rarely results in significant or startling changes on an annual basis.
• The relatively recent development of chronic disease programs and hence the need for objectives focusing on state capacity to address chronic diseases.
  • Chronic disease programs are relatively new in the public health world. For example, only recently have all states received funding for diabetes control programs. CDC's State tobacco control programs are only four years old. 1998 marked the first year of CDC's state-based cardiovascular disease prevention program, but funds are only available to fund 8 states. While all States now participate in the Behavioral Risk Factor Surveillance System (BRFSS), which represents our only method of monitoring adult chronic disease prevalence, some still lack any federal support for cancer registries. Because of the newness of chronic disease programs, many states are still putting into place the basic infrastructure of people, networks, and systems needed to conduct effective prevention programs. Further, with the exception of the National Breast and Cervical Cancer Early Detection Program, none of CDC's chronic disease programs are focused on service delivery. Instead, they are focused on developing the policies, environments, and systems which are supportive of healthy behavior and appropriate health care.
• The availability of annual data to measure performance.
  • CDC's data collection systems for monitoring chronic diseases are collected annually for adults (BRFSS), but only biennially for adolescents (YRBSS). While these data collect valuable information about the chronic disease behavioral risk factors, they are not designed to collect specific outcome data on chronic diseases.
• The opinions and recommendations of our key stakeholders.
  • CDC's efforts to achieve improvements in health behaviors, appropriate health care, and chronic disease burden are dependent on collaborative relationships. Reductions in our nation's future chronic disease burden will depend on the commitment and success of programs coordinated by CDC and a broad range of efforts by health care providers, medical and public health researchers, state and local public health and education agencies, insurers and payers of private medical insurance, other Federal agencies, and the private and non-profit sectors. CDC's key chronic disease partners have voiced concern regarding their ability to demonstrate specific outcome measures related to chronic disease issues and are committed to a balance between outcome and process objectives.
• Recognition that efforts to reduce the burden of chronic diseases must involve multiple public, private, and non-profit entities across the country.
  • Chronic diseases are a community-wide burden. CDC partners with the leaders of state and local health and education agencies, academic institutions, national organizations, non-profit agencies, business and philanthropies to reduce the burden of chronic diseases

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