Chronic diseases—such as heart disease, cancer, and diabetes—are among the leading causes of death and disability in the United States. These diseases account for 7 of every 10 deaths and affect the quality of life of 90 million Americans.xxiii Although chronic diseases are among the most common and costly health problems, they are also among the most preventable.
AHRQ, AoA, CDC, CMS, FDA, HRSA, IHS, OD, OPHS, and SAMHSA currently support a variety of programs and initiatives aimed at reducing the prevalence of chronic diseases and helping people with chronic conditions manage their diseases more effectively. State and local health departments, national and international health organizations, philanthropic foundations, and professional, voluntary, and community organizations are key partners in these health promotion and disease prevention activities. In the period of 2007–2012, these agencies will continue to support these activities and will work to expand, enhance, and improve their effectiveness. The Department selected key performance indicators that represent a broad array of activities, including cardiovascular health, cancer screening, and programs to reduce substance abuse and suicide.
A paradigm shift has occurred in health care, resulting in a renewed emphasis on prevention. To reap the benefits of prevention, both health care providers and health care consumers must first understand what those benefits are. The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 (Public Law 108-173) expanded Medicare’s menu of preventive benefits by covering an initial preventive physical examination. This benefit, also referred to as the “Welcome to Medicare” visit, allows new Medicare beneficiaries to get up-to-date information on important screenings and vaccinations, as well as to talk with their health care provider about their medical history and how to stay healthy. All beneficiaries enrolled in Medicare Part B with effective dates that begin on or after January 1, 2005, will be covered for this benefit.
The Welcome to Medicare visit enables the health care provider to provide a comprehensive review of his or her patient’s health, to identify risk factors that may be associated with various diseases, and to detect diseases early when outcomes are best. The health care provider is also able to educate his or her patient about the Medicare-covered services they need in order to prevent, detect, and manage disease; to counsel them on identified risk factors and possible lifestyle changes that could have a positive impact on their health; and to make referrals or followup appointments for necessary care. CMS will continue to support and conduct outreach related to the Welcome to Medicare benefit to increase beneficiaries’ utilization.
Although Medicare pays for many critical preventive screenings, fewer than 1 in 10 adults aged 65 or older receive all recommended screenings and immunizations. CDC’s Healthy Aging Program will continue to support a model program, Sickness Prevention Achieved through Regional Collaboration (SPARC), which has shown significant success in broadening the use of preventive services. SPARC promotes public access to services, helps medical practices provide preventive services, and strengthens local accountability for service delivery.
AHRQ accomplishes adoption and delivery of evidence-based clinical prevention services to improve the health of Americans through two main avenues: work in support of the United States Preventive Services Task Force (USPSTF) and Prevention Portfolio efforts aimed at dissemination and implementation of the Task Force’s recommendations. As the USPSTF makes evidence-based recommendations, it is the job of AHRQ to get the word out to clinicians and the general public as rapidly as possible. Accomplishing this goal more quickly puts actionable information into the hands of clinicians, guiding them to perform indicated services and not to perform services for which the evidence indicates more harm than benefit. Getting the word out increases the delivery of appropriate clinical preventive services. Clinicians and policymakers across the Nation hold the work of the USPSTF in high regard.
Heart Disease and Stroke
Heart disease and stroke are the most common cardiovascular diseases. For both men and women in the United States, heart disease and stroke are the first and third leading causes of death, respectively, accounting for nearly 40 percent of annual deaths.xxiv Although these largely preventable conditions are more common among people 65 years or older, the number of sudden deaths from heart disease among people aged 15 years to 24 years has increased. The economic impact of cardiovascular disease on the Nation’s health care system continues to grow as the population ages.
A key strategy for HHS in addressing heart disease and stroke and its risk factors is educating health practitioners and the public about the importance of prevention, about the signs and symptoms of heart attack and stroke, and about the importance of calling 911 quickly. To make women more aware of the danger of heart disease, the National Heart, Lung, and Blood Institute at NIH has collaborated with other organizations to sponsor a national campaign called The Heart Truth. The campaign’s goal is to raise women’s awareness about their risk of heart disease, and has resulted in striking improvements in women’s awareness of heart disease and their acknowledgment of personal risk. CDC’s Heart Disease and Stroke Prevention Program will continue to help States control high blood pressure and high blood cholesterol, both of which are risk factors for cardiovascular diseases, among residents; increase awareness of the signs and symptoms of heart attack and stroke; improve emergency response; improve quality of care; and eliminate health disparities. Medicare’s preventive services cover cardiovascular disease screenings.
HHS will continue to provide national leadership to prevent death and disability from heart disease and stroke and to expand support to State cardiovascular disease prevention efforts. FDA also contributes to prevention of heart disease through its food labeling regulations. For example, the recent requirement for trans-fat information on food labels provides consumers with additional information on the fat content of packaged foods. Reductions in consumption of trans-fatty acids are expected to reduce the risk of heart disease significantly.
Cancer is the second leading cause of death in the United States and costs approximately $210 billion annually.xxv Cancer does not affect all racial or ethnic groups equally. African-Americans are more likely to die of cancer than any other racial or ethnic group, revealing a large health disparity related to this disease. CDC’s National Comprehensive Cancer Control Program funds States, territories, and tribes to build coalitions, assess the burden of cancer, determine priorities, and develop and implement comprehensive cancer control programs. These programs help communities across the country to reduce cancer risks, detect cancers earlier, improve cancer treatment, and enhance quality of life for cancer patients. CDC is supporting these programs to ensure that cancer prevention and control reaches those at highest risk of developing cancer and in the greatest need of assistance.
CDC’s National Program of Cancer Registries collects data on the occurrence of cancers through State and territorial registries. CDC is supporting cancer registries throughout the United States to enable public health professionals to better understand and address cancer and its causes.
Making cancer screening, information, and referral services available and accessible to all Americans is essential for reducing the high rates of cancer and cancer deaths. CDC’s National Breast and Cervical Cancer Early Detection Program will continue to support screening and diagnostic exams for low-income women with little or no health insurance. The program will also support education and outreach, and case management services. CDC’s prostate cancer control initiatives support information dissemination to the public, physicians, and policymakers about the risks and benefits of prostate cancer screening.
FDA advances cancer prevention through the development and licensure of cancer prevention vaccines.
Included in Medicare’s menu of preventive services are screenings for colorectal and prostate cancer, as well as annual mammograms for women 40 years and older.
Overweight and Obesity
Over the last 20 years, rates for overweight and obesity have increased dramatically in the United States. Obesity has now reached epidemic proportions. CDC reports that two-thirds of noninstitutionalized U.S. adults age 20 and older are overweight or obese; a third are obese.xxvi The epidemic is not limited to adults, however. The percentage of young people who are overweight has more than doubled in the last 20 years. People who are obese are at increased risk for heart disease, high blood pressure, diabetes, and some cancers.
CDC, FDA, and OPHS are the primary HHS operating divisions working to reduce obesity and overweight in the United States, with a focus on improving nutrition and increasing physical activity. CDC will continue to support efforts to address obesity through provision of technical assistance, training, and consultation to funded State programs. CDC and its partners create, evaluate, and monitor programs, policies, and practices to prevent and control obesity. CDC will expand communication efforts to promote physical activity and good nutrition in worksites, schools, and health care settings.
FDA also contributes to obesity control through its food labeling regulations and education programs. For example, Make Your Calories Count, FDA’s Web-based learning program, helps consumers make informed choices that contribute to lifelong healthy eating habits.
The OD physical fitness program, I Can Do It, You Can Do It, targets the obesity and overweight challenges of children and youth through physical exercise based on the awards system of the President’s Committee on Physical Fitness and Sports Program. The program includes a mentee-mentor relationship and an evaluation component.
In addition, Dietary Guidelines for Americans provides science-based advice to promote health and to reduce risk for major chronic diseases and conditions, through diet and physical activity. Major causes of morbidity and mortality in the United States are related to poor diet and a sedentary lifestyle. Combined with physical activity, following a diet that does not provide excess calories, according to the recommendations in this document, should enhance the health of most individuals.
As a companion to the Dietary Guidelines for Americans, HHS will work over the next 2 years to develop comprehensive guidelines, drawn from science, to help Americans fit physical activity into their lives. The Physical Activity Guidelines for Americans will be issued in late 2008. The Physical Activity Guidelines will summarize the latest knowledge about activity and health, with depth and flexibility targeting specific population subgroups, such as older adults and children. This work is inspired by the President’s personal dedication to physical fitness and his desire that every American have access to science-based guidelines.
In the last 15 years, the number of people in the United States with diagnosed diabetes has more than doubled, reaching 14.6 million in 2005.xxvii Diabetes, which is also associated with overweight and obesity, can cause heart disease, stroke, blindness, kidney failure, pregnancy complications, lower extremity amputations, and deaths related to influenza and pneumonia. In addition to the millions of Americans with diabetes, an estimated 41 million adults aged 40 to 74 are prediabetic and are at high risk of developing diabetes.xxviii The increasing burden of diabetes and its complications is alarming. However, much of this burden could be prevented with early detection, improved delivery of care, and better education on diabetes self-management.
CDC monitors the burden of diabetes nationally and will continue to explore better ways to collect diabetes data on groups most at risk. CDC also provides funding for capacity building and program implementation to States and territories for diabetes prevention and control programs. Over the next 5 years, CDC will expand the number of implementation grants after first developing grantee capacity through phase one capacity grants.
CDC also works with NIH to support diabetes education. These operating divisions will continue to collaborate to enhance the network of more than 200 public and private partners who work to increase knowledge about diabetes and its control among health care providers and people with or at risk for diabetes. IHS also will support diabetes prevention and control through mobilizing and involving American Indian/Alaska Native communities to promote diabetes management strategies. For Medicare beneficiaries diagnosed with prediabetes and those previously tested who have not been diagnosed with prediabetes, or those who have never been tested for the disease, diagnostic screening tests are available. For Medicare beneficiaries with diabetes, Medicare offers Diabetes Self-Management Training and Medical Nutrition Training.
Mouth and throat diseases, which range from cavities to cancer, cause pain and disability for millions of Americans each year. This fact is disturbing because almost all oral diseases can be prevented. For children, cavities are a common problem that begins at an early age. Tooth decay is also a problem for U.S. adults, especially for the increasing number of older adults who have retained most of their teeth. Despite this increase in tooth retention, tooth loss remains a problem among older adults.
CDC is the lead Federal agency responsible for promoting oral health through public health interventions. CDC has and will continue to assist States in strengthening their oral health programs, reaching people hardest hit by oral diseases, and expanding the use of measures that are proven effective in preventing oral diseases. CDC currently provides 12 States with funds, technical assistance, and training to build strong oral health programs. Eight of the 12 States receive funding to develop and coordinate community water fluoridation programs or school-based dental sealant programs. With CDC support, States can better promote oral health, monitor oral health behaviors and problems, and conduct and evaluate prevention programs.
The use of alcohol, tobacco, and illicit drugs exacts a significant health and economic toll on individuals and communities in the United States. In 2005, 19.7 million (8.1 percent) Americans aged 12 years and older used an illicit drug, 71.5 million (29.4 percent) used a tobacco product, and 126 million (51.8 percent) used alcohol.xxix Tobacco use is the leading preventable cause of death in the United States, resulting in approximately 440,000 deaths each year.xxx
CDC supports basic implementation programs to prevent and control tobacco use in the States, territories, and tribal areas. CDC also works with a variety of national and international partners to promote action through partnership in tobacco control efforts with WHO and WHO Member States. Building on these existing activities and partnerships, CDC will work to engage business sectors in supporting comprehensive tobacco prevention and control programs, including the benefits of tobacco-free workplaces and the importance of access to cessation services to employees who are trying to quit smoking. For Medicare beneficiaries who use tobacco, cessation counseling is a covered preventive service.
As part of its efforts to reengineer its approach to substance abuse prevention, SAMHSA has created a strategic framework that is built on science-based theory, evidence-based practices, and the knowledge that effective prevention programs must engage individuals, families, and entire communities. SAMHSA’s new Strategic Prevention Framework (SPF) sets into place a step-by-step process that empowers States and communities to identify their unique substance use problems, build or enhance infrastructure to support solutions, and implement the most effective prevention efforts for their specific needs. It also includes monitoring and evaluation to ensure accountability and effectiveness of the program effort. SAMHSA will continue to utilize the SPF and expand its use through its State and local grant programs.
For every two victims of homicide in the United States, there are three Americans who take their own lives. Suicide is a potentially preventable public health problem. Studies of youth who have committed suicide have found that 90 percent had a diagnosable mental and/or substance abuse disorder at the time of their death.xxxi SAMHSA supports activities authorized by the Garrett Lee Smith Memorial Act of 2004 (Public Law 108-355), which support statewide youth suicide intervention and prevention strategies in schools, institutions of higher education, juvenile justice systems, substance abuse and mental health programs, foster care systems, and other youth support organizations. Additionally, OD is working on an initiative to understand and help prevent suicide among persons with disabilities and those who incur disabilities.
Chronic conditions currently limit activities for 12 million older people living in community settings in the United States; 25 percent of these individuals are unable to perform basic activities of daily living, such as bathing, shopping, dressing, or eating. Furthermore, falls are the leading cause of injury-related deaths and hospital admission among older people and account for between 20 billion and 30 billion health care dollars in the United States each year. These numbers will increase dramatically in the coming years with the aging of the Baby Boom Generation. AHRQ, AoA, CDC, CMS, and NIH contribute to research, demonstrations, the setting of national standards and guidelines, and the provision of grants and technical assistance to help older adults manage their chronic diseases and prevent falls and to encourage them to live healthy and active lifestyles.
For example, AoA funds an Evidence-Based Disability and Disease Prevention grant program and public/private partnership which deploys proven disability and disease prevention programs at the community level that empower older individuals to make behavioral changes that will reduce their risk of disease, disability, and injury. AHRQ and AoA, in collaboration with CDC, CMS, and NIH, are developing and testing a special Knowledge Transfer program targeted at State and local agency staff to promote and facilitate the utilization of evidence-based disease prevention programs for older people at the community level. CDC funds fall prevention research, research dissemination, and research translation and implementation that help decrease falls and increase stability in mobile older adults. CMS is demonstrating a health promotion and disease prevention program through the Medicare Senior Risk Reduction Demonstration to determine whether health risk reduction programs that have been developed, tested, and shown to be effective in the private sector can be tailored to the Medicare program to help beneficiaries improve their health and thus reduce the need for health care services.