IOM presents blueprint to combat chronic disease

Chronic diseases are known to be leading causes of death and disability, yet federal officials say not enough attention is being paid to improving quality of life for the more than 133 million Americans living with these illnesses.

A 304-page Institute of Medicine report, released Jan. 31, outlines recommendations to bolster population-based public health efforts, reduce disability rates and mitigate suffering caused by diseases such as arthritis, asthma, diabetes and heart disease.

A broad range of chronic illnesses cause varying levels of disability for an estimated 48 million Americans, the report said. More than one in four Americans is diagnosed with two or more chronic diseases, with the prevalence of multiple chronic conditions increasing substantially for those over age 65.

Chronic diseases also take a major toll on the U.S. economy, accounting for up to 75% of the nation's $2 trillion in annual health care spending.

"Maintaining or enhancing quality of life for individuals living with chronic illnesses has not been given the attention it deserves by health care funders, health systems, policymakers and public health programs and agencies," the report said.

More can be done by federal, state and local governments to help people live better with chronic illness, said Robert Wallace, MD, who chaired the IOM committee that wrote the report. Public health initiatives have had some success preventing disease, but such programs also should help people with chronic disease avoid developing concurrent conditions or worsening their conditions, he said.

"Unfortunately, lots of people have more than one chronic illness," said Dr. Wallace, professor of epidemiology and director of the University of Iowa Center on Aging. "When you look across the spectrum, a lot of the conditions that people have may be less preventable but may be more intervenable."

Improving quality of life

The report, commissioned by the Centers for Disease Control and Prevention and the Arthritis Foundation, recommends 17 strategies to support public health action. They include more surveillance and research, increasing federal support for states to develop comprehensive population-based strategic plans, evaluating the effectiveness of programs that serve people with chronic disease, and raising awareness about decreasing related health disparities.

The CDC should develop policy goals aimed at decreasing suffering from chronic disease, rigorously evaluate the effectiveness of chronic disease prevention programs that it funds, and routinely evaluate policies to ensure they align with current health system and insurance reforms, the report said.

The IOM committee also recommended that federal and state policymakers develop incentive programs for employers to provide health promotion programs that benefit people with chronic illness and that the Dept. of Health and Human Services establish a work group to coordinate chronic disease surveillance nationwide.

The report is timely and compelling, said Keith Lind, senior strategic policy adviser with the AARP Public Policy Institute. He commended the IOM committee for drawing attention to important issues that AARP has supported, such as the need to enhance research examining the effectiveness of programs that serve people with chronic illness and to rapidly evaluate programs aimed at improving outcomes for people with chronic illnesses.

The report outlines a comprehensive framework of coordinated strategies that can reduce the individual and societal burdens of chronic disease, said Arthritis Foundation President and CEO John H. Klippel, MD.

"Arthritis is the leading cause of disability in the U.S. and results in people losing their independence and their ability to care for themselves and their other chronic diseases," Dr. Klippel said. "We're excited to embrace this new vision and welcome new partners to reduce the impact of all chronic illness in this country."