The emergence of chronic diseases as the predominant challenge to global health is undisputed.1, 2, 3, 4 In its 2010 report on the global status of the challenges presented by chronic diseases, WHO noted that non-communicable conditions—including cardiovascular diseases, diabetes, cancers, and chronic respiratory diseases—accounted for nearly two-thirds of deaths worldwide.5
The updated Global Burden of Disease Study, 2010 provides further documentation of the continued shift from communicable to non-communicable diseases, and from premature death to years lived with disability.4 Related research indicates the scope of the problem and key risk factors that cause the global trends, including high blood pressure, tobacco smoking and second-hand smoke exposure, high body-mass index (BMI), physical inactivity, alcohol use, and diets low in fruits and vegetables and high in sodium and saturated fats (eg, artificial trans fats).4, 6, 7
In the USA, chronic diseases are the main cause of poor health, disability, and death, and account for most of health-care expenditures.8, 9, 10, 11 Around half (50·9%) of adults in the USA have at least one chronic condition and 26% have two or more conditions.12 In 2011, 13·1% of the population had a disability, including 46·3% of those in people aged 75 years and older.13 In 2011, ten of the 15 leading causes of death in the USA were chronic conditions, including seven in the top ten (diseases of the heart, malignant neoplasms, chronic lower respiratory diseases, cerebrovascular diseases, Alzheimer's disease, diabetes, and the combination of nephritis, nephrotic syndrome, and nephrosis).8
The Institute of Medicine reported that the USA is less healthy in key areas—including obesity, diabetes, heart disease, chronic lung disease, and disability—compared with 16 high-income or peer countries.14, 15, 16 The provision of care for people with chronic illnesses is very costly; in 2010, total spending for the Medicare population (largely people ≥65 years) was more than US$300 billion, with almost all (93%) spending in support of people with two or more chronic conditions.11 Similarly, lost productivity from chronic diseases, other chronic conditions, and risk factors is associated with enormous costs both for those remaining in the workforce and for those who prematurely leave because of a disability.17
Key messages
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Non-communicable diseases (eg, cardiovascular diseases, diabetes, cancers, and chronic respiratory diseases) account for most deaths globally, and are the main drivers of morbidity, disability, and health-care costs in the USA.
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Much of the chronic disease burden results from a small number of key risk factors that include high blood pressure, tobacco smoking and second-hand smoke exposure, high BMI, physical inactivity, alcohol use, and diets low in fruits and vegetables and high in sodium and saturated fats. Most adults in the USA have more than one risk factor.
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All of these risk factors can be effectively addressed at both the individual and population levels; work at both levels is essential. To address the challenge of chronic diseases needs a sustained cross-sectoral policy and programme focus on high-value prevention targets at the individual (clinical) and population levels.
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Reduction to the chronic disease burden needs coordinated and mutually-reinforcing actions: epidemiology and surveillance to monitor trends and track progress, policy and environmental approaches to promote health and support healthy behaviours, health-care interventions to improve the effective delivery and use of preventive and other high-value clinical services, and links between community programmes and clinical services to improve and sustain the management of chronic conditions.
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Establishment of community conditions to support behaviours that lead to a healthy life and promote effective management of chronic conditions will deliver healthier students to schools, healthier workers to employers and businesses, and a healthier population to the health-care system.
US national health priorities include prevention of the development and early detection of chronic diseases, slowing disease progression, mitigating complications to optimise quality of life, and a decrease in the demand on the health-care system.18, 19, 20 In this review, we assess the burden of chronic diseases in the USA, and describe the USA's public health practice-focused approach that is used by CDC's National Center for Chronic Disease Prevention and Health Promotion to reduce the preventable burden of chronic diseases.