Prevention Makes Common "Cents". Executive Summary

Expenditures for health care in the United States continue to rise and are estimated to reach $1.66 trillion in 2003. Much of these costs can be attributed to the diagnosis and treatment of chronic diseases and conditions such as diabetes, obesity, cardiovascular disease and asthma.

  • Approximately 129 million U.S. adults are overweight or obese which costs this Nation anywhere from $69 billion to $117 billion per year.
  • In 2000, an estimated 17 million people (6.2 percent of the population) had diabetes, costing the U.S. approximately $132 billion. People with diabetes lost more than 8 days per year from work, accounting for 14 million disability days.
  • Heart disease and stroke are the first and third leading causes of death in the United States. In 2003 alone, 1.1 million Americans will have a heart attack. Cardiovascular diseases cost the Nation more than $300 billion each year.
  • Approximately 23 million adults and 9 million children have been diagnosed with asthma at some point within their lifetime, with costs near $14 billion per year.

A much smaller amount is spent on preventing these conditions. There is accumulating evidence that much of the morbidity and mortality associated with these chronic diseases may be preventable.

For many Americans, individual behavior and lifestyle choices influence the development and course of these chronic conditions. Unhealthy behaviors, such as a poor diet, lack of physical activity, and tobacco use are risk factors for many chronic conditions and diseases. A high calorie diet and sedentary lifestyle commonly result in excessive weight gain. Overweight and obesity are risk factors for a large number of chronic diseases, most significantly, type 2 diabetes, congestive heart failure, stroke, and hypertension. Encouraging individuals to adopt healthy habits and practices may reduce the burden of chronic disease in communities throughout the United States.

Recently, public and private efforts and programs are increasingly designed to promote healthy behaviors. Employers are becoming more aware that overweight and obesity, lack of physical activity, and tobacco use are adversely affecting the health and productivity of their employees and ultimately, the businesses' bottom line. As a result, innovative employers are providing their employees with a variety of work-site-based health promotion and disease prevention programs. These programs have been shown to improve employee health, increase productivity and yield a significant return on investment for the employer. For example, a recent review of health promotion and disease management programs found a significant return on investment for these programs, with benefit-to-cost ratios, ranging from $1.49 to $4.91 (median of $3.14) in benefits for every dollar spent on the program. Several major companies with award-winning cost-saving health promotion disease prevention programs are profiled in this report and include:(1)

  • Motorola's wellness program, which stet the company $3.93 for every $1 invested.
  • Northeast Utilities WellAware Program, which in its first 24 months reduced lifestyle and behavioral claims by $1,400,000.
  • Caterpillar's Healthy Balance program, which is projected to result in long term savings of $700 million by 2015.
  • Johnson & Johnson's Health and Wellness Program, which has produced average annual health care savings of $224.66 per employee.

By changing the way they live, individual Americans could change their personal health status and the health landscape of the Nation dramatically.

In 2003, it is estimated that the U.S. will spend $1.66 trillion on health care expenditures.(2) Health care spending is growing faster than the gross domestic product (GDP) and is projected to account for 17.7 percent of the GDP by 2012, up from 14.1 percent in 2001. A small number of chronic disorders-such as diabetes and cardiovascular diseases-account for the majority of deaths each year, and the medical care costs of people with chronic diseases account for more than 75 percent of the nation's medical care costs.(3) As the population of the United States ages substantially over the next several decades, the prevalence of chronic diseases--and their impact on health care costs--will likely increase.

Each individual's health is shaped by many factors including medical care, social circumstances, and behavioral choices.(4) Increasingly, there is clear evidence that the major chronic conditions that account for so much of the morbidity and mortality in the U.S., and the enormous direct and indirect costs associated with them, in large part are preventable-and that to a considerable degree they stem from, and are exacerbated by, individual behaviors. In particular, overweight and obesity, lack of physical activity, and smoking greatly increase the risk of developing the most serious chronic disorders. Most of the dollars spent on health care in the United States, however, are for the direct care of medical conditions, while only a very small portion is targeted on preventing those conditions.(5) As Americans see health care expenditures continue to increase, it is important to focus on strategies that reduce the prevalence and cost of preventable diseases. This paper summarizes recent research findings on the prevalence, effects and costs of some of these key preventable conditions and highlights several award-winning business prevention programs that make common "cents."(6)

"So many of our health problems can be avoided through diet,
exercise and making sure we take care of ourselves. By
promoting healthy lifestyles, we can improve the quality of life
for all Americans, and reduce health care costs dramatically
Tommy G. Thompson, Secretary, DHHS

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