When it comes to chronic disease, I think prevention is important, but I think as health professionals we need more intervention programs that help and teach people how to deal with behavior change. As we have all probably learned, changing a person's behaviors is very difficult and the process is long and lengthy. Especially when it comes to diet, physical activity, and lifestyle changes....we really need to work with the community and make them believe that it is an important issue. I think it is also really important to get insurance companies to fund more preventive health screenigs and provide more education within the healthcare community.
Chronic diseases is a tough problem to tackle because these conditions, disease often begin developing years before the impact is really large and life changing.

Prevention

Arguably, our health care system has done a good job on treating chronic diseases. If they don't find a cure for something they find ways to delay the development of the disease. However, this has lead to an increase in length of life with a chronic disease as opposed to a long healthy life. This costs our health care system a lot as the expensive treatments now go for much longer periods of time. I believe that thus far we have been looking for a solution in the right direction. Prevention is key to avoiding the high expenses. Nevertheless, a stronger effort needs to be made in the area of policy. If we look at the past, we'll notice that some of the greatest victories against unhealthy behaviors has been through policy... think of smoking, for instance. Many people in our society think very little of the effects their current health behaviors will have on their future. That's why policy becomes our greatest weapon, as it automatically leads these people in the right direction towards healthy behaviors.

chronicles of narnia

chronic diseases are really going to be bringing our costs up.  there are many things that people have already addressed in the previous posts, in which i feel have sufficiently been voiced.  if the chronic disease is something that is in the hands of the individual, i think that we need to advocate health behaviors to the public that will help steer them clear of the adverse health behaviors.  what we really need to do is get the higher echelons of government to get behind these preventative issues, even though results are not always seen immediately, action has to be taken to save the future of our country.  it is in our hands.  we need to make the world realize that they will be responsible for their own actions, and their health, and the welfare of our future generations is in their hands.  a burden of that stature should not be taken lightly.  if you have a secret locked closet in your house, and you tell your friends not to try to get in there, there is a possibility that some of your friends will get curious and then want to try and get inside.  however, if they see the consequences and show them a video of the last set of friends who opened the closet and died from a ray of light that shines as soon as you open it, they will surely be less likely to try and get inside.  we need to show the world that video.  we need everyone to realize what will become of our future if we stay on the path that much of our society has chosen to follow.  our world has reached a fork in the road.  red pill or the blue pill? 

this one's a tough one...

Prevention is key, of course, to those that have the ability to prevent exacerbations in health. . . but it is also safe to say that our current lifestyles will develop chronic diseases for those that cannot take preventive measures with the progress of their symptoms, so how can we have a preventive approach to an inevitable occurrence? In addition, the questions posed by Professor Stevens are so difficult to answer, because I begin to think about our discussion on all contributing factors to prevention and health care complications (i.e. the intermixing of SES, race, education, and access – to name a few).

As a preventive method: connecting patients, their families and healthcare providers to the right information at the right time (education). This would result on patient empowerment and control of their health.

We need to evaluate the quality of life in this country and make it a priority over money. Prevention sounds ideal, but like it was mentioned by our lecturer the day we watched Sicko, “Public health is key to good health”
In addition, “let a person live 90 years of good health and not crappy but immense effort in the last 6 months”. This can be through, prevention, education, and maintenance/control before it’s too late.

This is a definite tough question to answer. Too many factors are associated…

Prevention, Policy, and Managment

Chronic diseases are burdensome on our current healthcare system because they usually persist throughout life, are increasingly prevalent, and are poorly managed. Many chronic diseases occur as a consequence of lifestyle. Unlike, many other health problems many chronic diseases CAN be easily addressed through non-medical measures, such as diet and exercise. The key to reducing the burden of chronic diseases is through prevention. This prevention can be achieved through preventative medicine approaches, such as increased screening and guidance on lifestyle issues by primary care doctors. Additionally we must enact policies that support healthier lifestyles. There are many that already exists, such as smoking restrictions in public places and the requirement of nutrition labels on foods. However, it is evident that these policies still fall short. We must enact policies that further promote healthy lifestyles, such as school-based nutrition and physical activity programs and mandates to primary care doctors in regards to preventative care.

In addition to the prevention of chronic conditions we must also improve our current regimen for how we manage these conditions. Unfortunately, too many patients don't full understand the implications of their conditions and make very little effort to improve their health. When they ultimately suffer the consequences of their inaction our healthcare system suffers as well. Many of the later stages of chronic conditions involve very costly treatments and procedures. 

The best example of this is the burden of diabetes. Many individuals that develop diabetes have the opportunity to avoid this disease through lifestyle changes. If they are screened while pre-diabetic there is a window of opportunity to motivate them to change their lifestyle and avoid diabetes. However if this fails and they develop diabetes they are now in a new category of disease management rather than prevention. Tight control of blood sugars in diabetic patients is key to preventing or delaying the onset of more costly complications. However, when this too fails we are left with patients that have few lifestyle options left to improve their health and we must manage them with more costly treatments, like dialysis. 

Fear Factor

Translation: You're a dead man!

I know this sounds a bit dramatic (and maybe controversial), but fear is something that works and is not used enough in influencing personal decisions in managing individual health. Subduing, managing, and potentially eliminating chronic diseases takes will. That will must sustain from a powerful source in order to survive throughout the process of living that healthy lifestyle. Looking at some of the results from the anti-tobacco ads that highlight mortality as a key theme, we can see that positive results are probable. There is no greater humility than realizing one's mortality, and understanding that certain behaviors may contribute to an untimely death. Having healthcare professionals, public health media campaigns, and even friends and family emphasize an individual's vulnerability to going 6 feet under sooner than they'd like may not be such a bad thing for that individual, or for the friends and family that care for and love that individual. There's nothing that gets things going like a little "tough love." The U.S. has been overly sensitive in being able to use this type of message: one that not only gets through that individual, but is very real and tangible.

Chronic Disease in America

The CDC says that chronic diseases in America are most common and extremely expensive, but that they are also the most preventable. Much of the chronic diseases in America can, at the very least, be reduced by adopting healthier behaviors. Simple lifestyle changes like eating healthier, exercising, and avoiding harmful substances can reduce risk and improve health. However, our culture and environment are often obstacles to making these changes. Positive health choices are difficult to make when there are fast food restaurants on every corner and other unhealthy activities in our immediate environment. I think that in order to really make an impact in reducing chronic disease, the government needs to enforce policy, implement health initiatives, and raise awareness. Places like schools are a good place to start because Americans would be reached at a younger age. Education on healthy behaviors can help stress the importance of prevention and offer tools to empower people to lead healthier lifestyles.

There is not question that chronic diseases account for a substantial amount of costs in a health care system. As more and more people are being inflicted with chronic illnesses such as heart disease and obesity, more attention needs to be placed on ways to prevent onset of diseases and to keeping costs low. Preventive care certainly would be an effective way to keep costs low through better health education, early detection, and better management of chronic illnesses. But I think we can do much more.

Our system oftentimes seems too aggregated for the proper treatment of serious chronic illnesses. As Craig mentioned earlier, Germany has Disease Management Programs that are specifically designed to treat specific chronic illnesses. I think implementing such a system would be beneficial to our current system. This would improve continuity of care and ensure a more effective method for treatment of various chronic illnesses.

gov't has a role

Besides preventative medicine, the government can have a role in reducing the incidence of chronic diseases. This issue was discussed in class earlier this semester, as suggested by Geetha. If a majority of chronic disease such as obesity and hypertension are caused by unhealthy eating habits, lack of exercise, and inaccessibility to healthy foods, then the government needs to take a stance on food regulation, reinforce physical education classes in school, and monitor nutritional data. 

The notion of chronic diseases usually does not worry people until they are a victim of a chronic disease. Avoidance of chronic diseases entails life-long management of health which should begin at birth. Adolescents and adults may not see themselves as targets for chronic disease because of the "invisibility" of begin young. Chronic disease may also be an isolated concept within medical and mph student, but for the general public, it usually isn't a daily concern. Mass communications can take a role in educating the public about the gravity of chronic diseases in America. Just like the anti-tobacco campaigns, chronic diseases deserves to be highlighted as well.

Chronic diseases........

The global prevalence of all the leading chronic diseases is increasing, with the majority occuring in developing countries and projected to increase substantially over the next 2 decades . Cardiovascular disease is already the leading cause of mortality in developing countries. Risks for chronic disease are also escalating. Smoking prevalence and obesity levels among adolescents in developing countries have risen over the past decade and portend rapid increases in chronic diseases. Strong beliefs persist that chronic diseases afflict only the affluent and the elderly, that they arise solely from freely acquired risks, and that their control is ineffective and too expensive and should wait until infectious diseases are addressed. Hence a change in stakeholders approach is required. People who take decisions about handling chronic diseases need to be provided with adequate evidence that this is a key area where funds need to be directed.

Compliance remains an important issue when tackling chronic disease. It is not easy to obtain good compliance. It is one thing instructing somebody to do things differently and another actually following the advise. There need to be ways to tackle compliance at a personal and professional level.

Follow up of patients with chronic disease is a herculean task. Our health care systems are not designed in such a way to maintain strict follow up of patients with chronic disease and this is another area where efforts directed could bring in dramatic changes in disease prevalence.

Patients suffering from chronic diseases require long term prescription drugs , sometimes lifelong. These medications need to be more affordable.

At last chronic diseases require more than just a physician, physiotherapists, occupational therapists, psychiatrists have a key role to play. A multidisciplinary approach is required on a dedicated basis to treat these patients.

Needless to say prevention tops the list, if a family has a known history of a chronic disease, individuals in that family should be given the education to equip themselves to avoid risk factors that could prevent them from developing the disease.

Prevention

Prevention is going to be the key ingredient in reducing our health care expenditures and the rates of chronic diseases.  If people begin taking control over their own health and well-being, they will obviously have a better quality of life and those dollars we are currently spending on their care can be put elsewhere.  The problem with all of this is the view of preventive care from the American society.  Many people simply don't understand what preventive care is; they don't realize that it is  lifestyle and not just random doctors visits or lab draws.  Unfortunately, many people do not want to or cannot afford to make this major change and that is where the problem is deeply rooted.  

Overall, I think chronic diseases are the single most burdensome aspect of health care costs and treatment in the United States.  Reducing the prevalence of chronic diseases could single-handedly drop health care expenditures by an incredible amount.  Like I mentioned before, prevention is going to be the answer to this problem.  The only question that remains is how long it will take for prevention to become a lifestyle and not just a theory.

Innovations to overcome chronic diseases

The problems associated with chronic disease and related outcomes might act as the tipping point in terms of being the catalyst for health care reform.  Quite simply, we cannot afford to continue treating chronic conditions in the population.  

There are a few new unique approaches going on elsewhere in the world in regards to chronic disease management and care.  Germany, without giving away too much information in regards to our presentation tomorrow, radically altered their health care delivery in response to the increasing costs associated with chronic disease.  Their research determined that 20% of the population were responsible for 80% of costs.  In response, they created Disease Management Programs, of which we will elaborate on tomorrow.

The Germany example illustrates one of many innovative approaches to treating those with chronic diseases. Researching chronic diseases will be a fundamental part health care in the coming decade (or sooner), their costs and burden on the system are still far from understood and vastly undervalued. 

Chronic disease is multi-faceted

Chronic diseases ARE multi-faceted, so the approach to treating them must be as well. Prevention is a huge part of this, and with that comes health education, promotion of healthier behaviors, policy change to reflect priority shifts, and research and development to know what course is best to take.

We've talked a lot about potential wide-spread health care reform in this country, and how all these little fixes don't actually amount to much change. The real problem as I see it is that each problem is treated as an individual problem, instead of being looked at in the context of a bigger issue. Health IT could be looked at in terms of chronic disease treatment. Health education could be looked at in terms of chronic disease treatment. Policy change could be looked at in terms of chronic disease treatment.... and on and on, you get my drift. Put all of these things together and you have one giant problem that is pleading with us to be fixed.

A huge problem is funding. Always funding. What if there was a shift in thinking to where it didn't matter how much we had to spend on health care to get the best case scenario - not we as in individuals, but we as in the government. After all, the proposed increase in SCHIP funding that President Bush so willingly vetoed TWICE was equal to just 16 days in Iraq -- and I can guarantee that not everybody is on the same page about those dollars. Just think, if we had unlimited dollars to spend on health care, we could do all the research we wanted, for the sake of discovering new things in science. We could provide everyone with the same, high quality of care. We could pay our physicians, yes even the primary care physicians, enough to where they wouldn't base their career choices on what specialty will pay off their medical school debt the fastest. We could educate the public to our heart's content about what is best for them, and how they can take responsibility for their health and their bodies, and not have to worry about cost. We could implement an interoperable, nationwide health IT system, with subsidies to get smaller practices and Medicare/Medicaid providers up and running. Scrap that, we could have universal coverage. The what-if's abound if we think about what we could do to better the health of our nation with unlimited funding and no ceiling on ideals. I truly believe chronic disease rates would go down with equity of care, prevention, treatment, education, dissemination of knowledge, and an overall shift in the way this country views health care.

Hopefully, something will change. Until then, I hope to someday be a doctor who can implement some of those ideals in any way possible.

Improving Chronic Illness Care

The article by Wagner et al, on Improving Chronic Illness Care states, that in order for improvements to happen, there must be changes in our care delivery system. A greater emphasis on prevention would ultimately be the best solution if people actually followed through with preventive behaviors. However, we live in a world where it is difficult to monitor people’s behavior because there are many choices of lifestyles. Also we must remember that nothing is perfect and there will always exist diseases due to biological reasons. In this case, we still need to come up with a plan to improve chronic disease care. The article, states that there has been advancement in the effectiveness of care of major chronic illnesses, but few people actually benefit from these advances. What good is it to have all these great solutions if they are not being effectively disseminated across the country, if not all people have access to long-term health care, if only a few people can afford treatments, and resources are limited? I believe that in order to reduce the prevalence of chronic illnesses, there needs to be a change in the health care system that not only puts a greater emphasis on prevention, but facilitates access to health care, improves long-term care, and provides community level resources to monitor and support healthy behaviors for those with chronic illness.

Patient Enpowerment

"Prevention" by definition implies that the end goal is to eradicate chronic illness, but I'm not sure if this is the best approach. Though many chronic illnesses are behavior-related (obesity is the prime example), I still feel that the majority are simply unavoidable consequences of aging. In the developed world, where the average lifespan keeps increasing year after year, it's no surprise that conditions such as diabetes, osteoporosis, and high blood pressure are also on the rise.  The contrast between developed and developing nations is shocking: while most of us die on ventilators in our old age (due to chronic obstructive pulmonary disease, high cholesterol, or any number of relatively managable conditions), people in the third world die abruptly of parasites, flesh-eating bacteria, cholera, and other infectious diseases over which they (as individuals) have little control.

Our healthcare system may have been founded to fight infectious disease, but now, as a developed nation that is no longer threatened by flesh-eating bacteria, etc., our healthcare system is rapidly becoming antiquated. 

Unlike infectious diseases, chronic diseases can't be "eradicated" in the traditional sense. I feel that chronic illness will always be present in one way or another, even if that "illness" amounts to nothing more than nature taking its course as we enter our 50s and 60s. Many people will make a conscious choice between their health and the other important aspects of life that might compromise that health--such as choosing to get 4 hours of sleep a night for a week straight in order to write grants (I'm looking at you, Greg...). So the notion of eradicating chronic illness altogether is a bit extreme.

What might make more sense for Western medicine in general is to change our system of healthcare delivery to encourage patients (rather than doctors) to take up the burden of care. With so much medical technology and free-flowing information at our disposal, I don't think it's unreasonable to move towards a delivery system in which patients play a much greater role in managing their own health. Medical paternalism is rapidly becoming an antiquity, and if we don't move completely away from it soon, it may very well become a liability.  

Health Promotion and Education

With chronic health issues on the rise, it is apparent that this trend has the potential to overload our health care system. As a future public health advocate and professional, I truly believe that health promotion and education is a vital component in alleviating this overload. By tackling certain health issues early on through preventative measures as well as educating individuals on how to improve their overall well-being will have a drastic impact on diminishing the increasing chronic health issues of Americans in general. As a clinician in the oral health care field, I have found that health promotion and education has proven to be very effective especially when it comes to preventing caries and periodontal disease (both of which have the potential to be chronic health issues if left untreated).

Approaches of prevention

I think when talking about chronic disease, 'prevention' could be a very broad topic.  Individuals, health institutions and government have different role to play for the same goal of fighting chronic disease.  The Partnership to Fight Chronic Disease (PFCD) has 3 major approaches fighting chronic disease: educating the public, mobilizing health institutions and challenging policies.

Before educating people how to prevent chronic disease, it's very important to have people realize that we should prevent chronic disease.  Prevention is difficult because IF PREVENTION IS SUCCESSFUL, NOTHING HAPPENS.  And there's no way we could interfere people's daily habits too much.  But considering the fact that chronic diseases are both the most preventable and among the most common and costly health problems, prevention would always be our first issue.

What else? For those chronic conditions which already exists, there's also things we should do.  Improve access to health services and cut health care costs can make a positive change of people's attitude towards their chronic condition, since chronic disease really costs a lot among all health care expenses.

Also I found something interesting.  Maryland is one of the leading states when it comes to health research and health care, but it has one of the largest chronic disease burdens in the country: more than 3 million cases and more than $25 billion every year in combined treatment costs and lost productivity.  What I can conclude is: the education of preventing chronic disease in Maryland might be a problem since how people turn into chronic conditions has nothing to do with health care.

we need to sell our health education in a persuasive way...

After reading several classmates' comments on this week's blog, I am strongly agree with them about prevention and education. Prevention is the key to change a person's behavior however we need to implement our preventive methods more effectively by putting marketing, advertising, psycholoigically together. We are selling a healthier choice to people but we need to make sure the target population get it and like it as well. I think when we are trying to stop somebody from doing something, we should also give them alternative choices that they feel they are not completely cut off from their addictive unhealthy behavior. For example, we all know fried chicken is not good for the health, then we can promote more of grill chicken (el pollo loco), then slowly advocate the idea of eating water broiled chicken or something. This is one of the psychology theories to change a person's behavior by changing by steps.

Education will be included in preventive method, and it should start as soon as possible. Target population will be 6 year old children and pregranted mothers. Pregranted women are very sentitive about their incoming babies and most of time they are extra careful on their health since they want their babies to be health, therefore, it will be a very good idea to educate the "soon-to-be" mothers on health education even before the babies are born.

Prevention: A good start but not the only solution

The growing prevalence of chronic disease is a complex problem that cannot be simply fixed with one solution. There are a plethora of factors and determinants that contribute to chronic disease that I think prevention is just one aspect that can help to deal with this problem. Of course, investing in prevention is a key aspect since it ultimately has the potential to decrease a person's health care costs down the line. Rather than spending the money to deal with a disease, why not prevent it in the first place. This not only prevents unnecessary drain on our limited health care resources, but it allows people to live at a higher quality of life and thus be more productive in society as opposed to be more of a burden. Although, to reap the benefits of prevention, a great deal of money must first be invested before any positive outcomes can begin to arise, which means greater health care spending upfront as opposed to down the line. This has caused prevention to be a hard sell because understandably so, people are always hesitant to put more money into something that they are not sure will have the effects that they anticipate or want. Thus, there needs to be more research done to prove the importance of preventive medicine.

In addition to prevention, I believe that reducing and ultimately eliminating health care disparities in our system will be key in decreasing the prevalence of chronic disease. The reason so many are forced to suffer with chronic conditions is because they don't have the luxury of going to a primary care provider and thus only seek medical attention only when they are already plagued with some type of problem. This is obviously not the most efficient way of handling these issues and so by allowing more people better access to more than just emergency care it should help quell this chronic disease problem.

Prevention is Key

I think that prevention is critical in tackling the growing prevalence of chronic disease in America. I also think that it is very important to educate our children for future, and healthier generations. Prevention can start at the elementary school-level, and I believe it will be very effective in shaping childrens' future decisions, and building healthy lifestyle habits. Prevention doesn't have to be complicated, it can start with making small changes in our every day lives.