American Perspectives on Chronic Disease and Control

by

Noreen M. Clark

• LAST REVIEWED: 22 April 2013
• LAST MODIFIED: 22 April 2013
• DOI: 10.1093/obo/9780199756797-0036

Introduction

Chronic conditions have been recognized by the World Health Organization as the primary worldwide disease-related cause of morbidity and premature mortality. The medical and public health systems of most countries have traditionally focused on acute and infectious ailments. However, the dramatic increase in the global prevalence of chronic illness has caused a slow but steady shift by public health and medicine toward prevention and management of chronic disease. As the means for primary prevention of most chronic conditions are unknown (an important exception being smoking and cancer), emphasis is generally given to secondary prevention; that is, the reduction in the extent of complications, deterioration of health status, and burden of disease. Several types of action are required in chronic disease control. One is the identification of, and intervention with, common factors known to exacerbate disease onset or management. Poverty, sedentary living, and poor diets are some examples of the most common factors. Another level of action is the reformulation of health systems that are organized to respond to acute ailments to account for the longer-term services and assistance required to effect chronic disease control. Yet another is building the capacity of individuals, families, communities, and systems to prevent and manage chronic illness. The strength of these capacities is influenced by the policies that create the training, resources, and systems required for effective community-wide disease control. The list of chronic diseases that plague the health of the world’s peoples is long. Rather than focusing on each of the illnesses that add to the dismaying health outcomes evident around the globe, this article will focus on the area of noncommunicable disease in general so as to provide a broad view of sources of information regarding major issues that may be common across conditions. This author would like to thank Ms. Lee Rose Schrauben, MPH, for her assistance in the preparation of this article.

Introductory Works

For a comprehensive picture of the global chronic disease control challenge, the United Nations, especially the World Health Organization (WHO), is an important source of information through its home page and widely available reports. Many reports set the stage for recognizing and controlling the effect and impact of chronic diseases. Beaglehole, et al. 2011 describes the recent UN meeting focused on global mobilization for control. A United Nations report established noncommunicable disease as a worldwide dominant health concern (World Health Organization 2010). For data regarding the United States, Centers for Disease Control and Prevention 2011 provides an online portal for understanding both the epidemiology of chronic disease and the primary federal US programs that respond to the challenge . A number of important articles explicate the central issues in disease control and provide perspectives on effective intervention. Geneau, et al. 2010 provides a model for generating political support for control efforts. Clark 2003 and Slonim, et al. 2010 provide views on the capacities required to manage noncommunicable conditions. For chronic disease control in the United States, US Department of Health and Human Services 2010, a new framework for action, is a highly relevant source of information. These publications intentionally shift perspectives and recommendations for actions toward Noncommunicable disease control. They recognize that strategies that are operative in infectious disease control are not necessarily appropriate for chronic conditions. The notions of rescue, cure, and elimination that are reflected in infection control are rethought. They are replaced with ideas that include reduction of disruption of daily life, maintenance of general health, adherence to long-term clinical recommendations, and relevant clinical, community, and social support systems available over the life span.

• Beaglehole, R., R. Bonita, R. Horton, et al. 2011. Priority actions for the non-communicable disease crisis. Lancet 377.9775: 1438–1447.

  DOI: 10.1016/S0140-6736(11)60393-0

  A 2011 UN meeting on noncommunicable diseases describes the need to mobilize countries to engage in a global movement “against premature death and preventable morbidity and disability.” Priorities include leadership, prevention, treatment, international cooperation, monitoring and accountability, and delivery of five priority interventions—namely tobacco control, salt reduction, improved diets and physical activity, reduction in hazardous alcohol intake, and essential drugs and technologies. Available online by subscription.

• Centers for Disease Control and Prevention. 2011. Chronic Disease: At a Glance Reports.

  The CDC comprehensively lists documents related to alcohol abuse, arthritis, cancer, diabetes, heart disease and stroke, obesity, epilepsy, and tobacco use. CDC efforts targeted at disease control include healthy communities, prevention research centers, preventive health and health services block grants, and school health programs. The CDC provides information regarding racial and ethnic gaps in chronic disease control and community approaches to reducing disparities.

• Clark, N. M. 2003. Management of chronic disease by patients. Annual Review of Public Health 24:289–313.

  DOI: 10.1146/annurev.publhealth.24.100901.141021

  Management of a disease by the patient is central to control of its effects. Interventions can produce positive outcomes, including monitoring of a condition, fewer symptoms, enhanced physical and psychosocial functioning, and reduced health-care use. Successful programs are theory based. Self-regulation is a promising framework for program development. Gaps in understanding and improving disease management by patients are described. Available online for purchase or by subscription.

• Geneau, R., D. Stuckler, S. Stachenko, et al. 2010. Raising the priority of preventing chronic diseases: A political process. Lancet 376.9753: 1689–1698.

  DOI: 10.1016/S0140-6736(10)61414-6

  Employs an “adapted political process model” to identify strategies for increased political support for chronic disease control and involvement of development agencies. Recommendations are: (1) emphasize social determinants of disease and interrelations among chronic disease, poverty, and development; (2) mobilize resources through a cooperation and inclusion approach to development and equitably distribute resources on the basis of avoidable mortality; and (3) merge strategic and political opportunities. Available online by subscription.

• “Noncommunicable disease control.” 2002. In Encyclopedia of public health. Vol. 3. Edited by Lester Breslow, 814–822. New York: Macmillan Reference.

  This entry provides concepts and details related to six priority topics in chronic disease control. These are: the ascendency of noncommunicable diseases as a worldwide health threat; the modifiable and nonmodifiable causes and means to prevent chronic disease; the environmental exposures found generally around the globe; the needed areas for research; and projection of trends and needs in the future. Available online.

• Slonim, A., F. C. Wheeler, K. M. Quinlan, and S. M. Smith. 2010. Designing competencies for chronic disease practice. Preventing Chronic Disease 7.2: A44.

  This article describes the outcome of a work group of the US National Association of Chronic Disease Directors convened to develop competencies required of professionals who practice chronic disease prevention and control. Concept mapping was used with existing public health competency statements to identify interrelationships among skills and knowledge required for leading and managing state chronic disease programs. Seven competency areas were highlighted.

• US Department of Health and Human Services. 2010. Multiple chronic conditions: A strategic framework. Washington, DC: US Department of Health and Human Services.

  This document produced at the behest of the US secretary of health and human services is the first to delineate the problem of comorbidities. The report underlines the fact that little is known and even less done to assist people with multiple conditions despite their significant growth in number and associated medical cost. It calls for new perspectives and actions in prevention and management of comorbidities by individuals, clinicians, and health systems.

• World Health Organization. 2010. Discussion paper: Regional high-level consultation in the European Region on the prevention and control of noncommunicable diseases. Geneva, Switzerland: World Health Organization.

  In May 2010 the UN General Assembly passed a resolution calling for the 2011 high-level meeting with heads of state and governments to consider prevention and control of chronic noncommunicable diseases. This report describes the historic step that recognized the dominance of chronic disease as the cause of premature death and morbidity worldwide. The report was written to support decision making in member states regarding how to combat noncommunicable diseases.