Nchc Fact Sheet - Prevention

Health Care Facts: Prevention Over the past century, the United States has made significant gains in treating illness and increasing life expectancy. Despite these improvements, rates of chronic disease are higher in the U.S. than in any other country—nearly half (45%) of Americans suffer from at least one chronic disease.1 Chronic diseases, such as heart disease, diabetes, pulmonary disease, and cancer, are among the most costly and preventable diseases in the United States.2, 3 Three out of every four health care dollars are spent treating chronic disease and seven out of ten deaths are caused by chronic disease.4 Figure 1 :

At least one third of deaths in the United States are attributable to a handful of unhealthy behaviors: smoking, poor nutrition, and lack of physical activity.5 Increasing our efforts to prevent and manage disease has the potential not only to improve the quality and length of life, but also to decrease health care spending. A study by the Milken Institute found that, if the U.S. can make modest improvements in prevention and management of disease by 2023, we could avoid 40 million cases of chronic disease and save $218 billion annually in treatment costs. Improved productivity due to a decrease in chronic disease could increase the GDP by $905 billion.6 (Figure 1)

Avoidable Treatment Costs and Output Losses, 2023 7

Sources: Figure taken from DeVol, Bedroussian, et al. (2007), Milken Institute tabulations from MEPS, NHIS.

TOBACCO Tobacco use is the number one cause of preventable death in the U.S.7 Smoking tobacco greatly increases the risk of premature death, cancer, heart disease, and many other negative health consequences.8 •

18.4% of American adults currently smoke cigarettes.9

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Lung cancer is largely preventable, yet more people die from lung cancer than any other type of cancer.10 Smoking or exposure to secondhand smoke is the primary cause of eight out of ten lung cancer cases.11

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Every year 443,000 Americans die prematurely from tobacco related disease.12 In other words, tobacco is responsible for almost one in five deaths in the United States.13

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The large majority of adult smokers began smoking before the age of 18 (nearly 80% by age 18 and nearly 90% by age 20).14 This suggests that preventing children from using tobacco could greatly reduce the prevalence of tobacco use and its associated health consequences.

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People who quit smoking greatly reduce their risk of heart disease, lung and other cancers, respiratory problems, poor birth outcomes for pregnant women, and premature death.15

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70% of American adult smokers report that they want to quit, yet less than 5% a year succeed.16 In 2008, only three states funded their tobacco prevention programs at the Center for Disease Control’s minimum recommended level, and 30 states spent less than half of the minimum level. Total state spending on tobacco prevention programs was less than 3% of the revenue generated from tobacco taxes and tobacco industry settlements.17

National Coalition on Health Care

August 2009

OBESITY

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Figure 2: Percentage of Obese 19 Percentage of Obese American20Adults American Adults

Percent Obese

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Obesity is largely preventable and increases the risk of many chronic conditions, such as heart disease, certain cancers, diabetes, high blood pressure, and many other diseases.18 •

20 15 10 5

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0 1995

2001 Year

Source: BRFS

2008

Nearly two thirds of Americans are overweighti or obese.ii Currently, more than one quarter (26.7%) of American adults are obese, compared to a prevalence of 15.9% in 1995.19 (Figure 2) Over the past three decades, the prevalence of obese children aged 6-19 has tripled.20 This is especially concerning considering that approximately 60% of obese children already have at least one risk factor for heart disease21 and are very likely grow up to be obese adults.22

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The Institute of Medicine estimated that children born in the United States in 2000 have a 30-40% chance of developing Type 2 diabetes at some point in their lifetime. The lifetime risk of developing Type 2 diabetes is even higher for racial and ethnic minorities.23

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Children from low-income households are more likely to be obese than children from higher income households (17.8% of children living below 100% of Federal Poverty Line (FPL) versus 11.7% of children living 400% and above FPL). Part of this disparity can be attributed to barriers that lowincome families face in accessing nutritious food, e.g. inadequate resources to purchase healthy foods and few sources of healthy foods in their community.24

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Obesity disproportionately affects racial and ethnic minorities. Compared to an obesity rate of 23.7% among Caucasians, over one third (35.7%) of African Americans and 28.7% of Hispanics are obese.25 COSTS

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In 2008, direct medical spending attributable to obesity was $147 billion—nearly double what was spent a decade ago. Obesity related health conditions account for almost one in ten (9.1%) health care dollars, compared to 6.1% of health care spending in 1998.26 These estimates do not include indirect costs such as absenteeism and reduced worker productivity.

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Health care spending for an obese person is on average $1,429 higher per year (42% higher) than for a person of normal weight.27

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During 2001-2004, the total economic burden of smoking was approximately $193 billion annually — $97 billion in spending for smoking-attributable health care and an additional $97 in lost productivity. By contrast, state-based tobacco prevention and control programs only received $595 million in 2007 — approximately 325 times less money than smoking-attributable costs.28

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According to the Trust for America’s Health, an annual investment of $10 per person in evidence-based community prevention programs can yield significant cost savings. In five years, Medicare and Medicaid alone could yield net savings of $7 billion annually, and total U.S. medical spending could be reduced by $16 billion annually.29 This fact sheet was research and prepared by Julie Bromberg on 8/7/09.

i ii

Overweight is defined as a Body Mass Index (BMI) equal to or greater than 25. Obese is defined as a BMI greater than or equal to 30.

National Coalition on Health Care

August 2009

References 1

Kott A, Fruh D, Cameron L, Greger C, Klein K, Lethert C, et al. “2009 Almanac of Chronic Disease: Impact of Chronic Disease on U.S. Health and Prosperity: A Collection of Statistics and Commentary.” Partnership to Fight Chronic Disease. 2009. Available at: http://www.fightchronicdisease.org/pdfs/2009_PFCDAlmanac.pdf 2 Centers for Disease Control. “Chronic Disease Overview” [Fact Sheet]. March 2008. Available at: http://www.cdc.gov/nccdphp/overview.htm 3 Woolf, SH. “The Big Answer: Rediscovering Prevention at a Time of Crisis in Health Care.” Harvard Health Policy Review, 7(2): 5-20. Fall 2006. 4 Kott A, Fruh D, Cameron L, Greger C, Klein K, Lethert C, et al. “2009 Almanac of Chronic Disease: Impact of Chronic Disease on U.S. Health and Prosperity: A Collection of Statistics and Commentary.” Partnership to Fight Chronic Disease. 2009. Available at: http://www.fightchronicdisease.org/pdfs/2009_PFCDAlmanac.pdf 5 Mokdad AH, Marks JS, Stroup DF, and Gerberding JL. “Actual Causes of Death in the United States, 2000,” JAMA, 291: 1238-1245. 2004. 6 DeVol R, Bedroussian A, et al. “An Unhealthy America: The Economic Burden of Chronic Disease.” Santa Monica, CA: The Milken Institute. October 2007. Available at: http://www.milkeninstitute.org/pdf/ES_ResearchFindings.pdf 7 Centers for Disease Control. “Cigarette Smoking Among Adults—United States 2006.” Morbidity and Mortality Weekly Review. 56(44);1157-1161. November 9, 2007. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5644a2.htm 8 Centers for Disease Control. “Smoking and Tobacco Use: Health Effects of Cigarette Smoking” [Fact Sheet]. May 2009. Available at: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm 9 Centers for Disease Control, Behavioral Risk Factor Surveillance System. Nationwide Tobacco Use [Data Set]. Accessed: July 23, 2009. Available at: http://apps.nccd.cdc.gov/brfss/ 10 American Cancer Society. “Cancer Facts and Figures 2009.” Atlanta: American Cancer Society. 2009. Available at: http://www.cancer.org/downloads/STT/500809web.pdf 11 Centers for Disease Control. “The Health Consequences of Smoking: A Report of the Surgeon General.” Atlanta, GA: U.S. Department of Health and Human Services. 2004. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2004/index.htm 12 Centers for Disease Control. “Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses— United States, 2000–2004.” Morbidity and Mortality Weekly Report, 57(45):1226–1228. Nov 14, 2008. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htm 13 Tejada-Vera B, Sutton PD. “Births, Marriages, Divorces, and Deaths: Provisional Data for October 2008.” National Vital Statistics Reports, 57(17). Hyattsville, MD: National Center for Health Statistics. June 26, 2009. Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_17.pdf 14 American Legacy Foundation. “Fact Clipboard” [Fact Sheet]. Calculated based on data in Substance Abuse and Mental Health Services Administration (SAMHSA), Results from the 2006 National Survey on Drug Use and Health (NSDUH), 2007. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Available at: http://www.americanlegacy.org/factsheets.aspx 15 Centers for Disease Control. “Smoking and Tobacco Use: Health Effects of Cigarette Smoking” [Fact Sheet]. May 2009. Available at: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm 16 Centers for Disease Control. “Cigarette Smoking Among Adults—United States 2006.” Morbidity and Mortality Weekly Review. 56(44);1157-1161. November 9, 2007. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5644a2.htm 17 Campaign for Tobacco Free Kids. “A Broken Promise to Our Children: The 1998 State Tobacco Settlement Nine Years Later.” Washington, DC: Campaign for Tobacco Free Kids. Dec 2007. Available at: http://tobaccofreekids.org/reports/settlements/2008/fullreport.pdf 18 Centers for Disease Control. “Overweight and Obesity: Health Consequences” [Fact Sheet]. May 2009. Available at: http://www.cdc.gov/obesity/causes/health.html 19 Centers for Disease Control, Behavioral Risk Factor Surveillance System. Nationwide Tobacco Use [Data Set]. Accessed: July 23, 2009. Available at: http://apps.nccd.cdc.gov/brfss/ 20 Centers for Disease Control, “Overweight and Obesity: Childhood Overweight and Obesity.” May 2009. Available at: http://www.cdc.gov/obesity/childhood/index.html 21 Institute of Medicine. “Preventing Childhood Obesity: Health in the Balance” [Fact Sheet]. Washington, DC: National Academies Press. Sept 2004. Available at: http://www.iom.edu/Object.File/Master/22/606/FINALfactsandfigures2.pdf 22 Centers for Disease Control, “Overweight and Obesity: Childhood Overweight and Obesity.” May 2009. Available at: http://www.cdc.gov/obesity/childhood/index.html 23 Institute of Medicine. “Preventing Childhood Obesity: Health in the Balance” [Fact Sheet]. Washington, DC: National Academies Press. Sept 2004. Available at: http://www.iom.edu/Object.File/Master/22/606/FINALfactsandfigures2.pdf 24 Robert Wood Johnson Foundation on Commission to Build a Healthier America. “Beyond Health Care: New Directions to a Healthier America.” Robert Wood Johnson Foundation. April 2009. Available at: http://www.rwjf.org/files/research/commission2009finalreport.pdf National Coalition on Health Care

August 2009

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Pan L, Galuska DA, Sherry B, Hunter AS, Rutledge GE, Dietz WH, and Balluz LS. Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion. “Differences in Prevalence of Obesity Among Black, White, and Hispanic Adults --- United States, 2006—2008.” Morbidity and Mortality Weekly Review, 58(27);740-744. July 17, 2009. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5827a2.htm 26 Finkelstein EA, Trogdon JG, Cohen JW, and Dietz W. “Annual Medical Spending Attributable To Obesity: Payer- And Service-Specific Estimates.” Health Affairs 28(5): w822-w831. July 27, 2009. Available at: http://content.healthaffairs.org/cgi/content/full/hlthaff.28.5.w822/DC1 27 Ibid. 28 Campaign for Tobacco Free Kids. “A Broken Promise to Our Children: The 1998 State Tobacco Settlement Nine Years Later.” Washington, DC: Campaign for Tobacco Free Kids. Dec 2007. Available at: http://tobaccofreekids.org/reports/settlements/2008/fullreport.pdf 29 Levi J, Segal LM, Juliane C, et al. “Prevention for a Healthier America.” Washington, DC: Trust for America’s Health. July 2008. Available at: http://healthyamericans.org/reports/prevention08/Prevention08.pdf

National Coalition on Health Care

August 2009