John Robitscher, CEO
National Association of Chronic Disease Directors.
Testimony – House Subcommittee on Labor-HHS-Education and Related Agencies

Thank you, Chairman Kingston and Ranking Member DeLauro, for allowing me to testify on behalf of the National Association of Chronic Disease Directors (NACDD).  Specifically, I want to express my support for increased funding for the key chronic disease programs which are all part of the National Center for Chronic Disease Prevention and Health Promotion at CDC.

NACDD is a non-profit public health organization which serves the chronic disease program directors of each state and U.S. jurisdiction and connects the more than 3,000 chronic disease practitioners across the country. 

As the United States seeks ways to regain our economic footing and rebuild prosperity, we must remember that poor health of the population can exert tremendous force on employment rates, interest costs, and other tangible factors that ultimately affect our ability to maintain a strong global economic position. The primary driver of cost in healthcare is chronic disease. Public health chronic disease prevention and control, which is managed by state health departments, focuses on risk factors and diseases, links the clinical and community sectors, and is the key to addressing this epidemic.

Chronic disease not only affects health and quality of life, but is also a major driver of health care costs and has a related impact on business, such as absenteeism and presenteeism. According to the Centers for Disease Control and Prevention (CDC), chronic disease accounts for approximately 75 percent of the nation’s aggregate health care spending – or an estimated $5,300 per person in the U.S. annually. In terms of public insurance, treatment of chronic disease constitutes an even larger portion of spending – 96 cents per dollar for Medicare and 83 cents per dollar for Medicaid. Behavioral choices that result in an increased incidence of chronic disease are also extremely costly in terms of the affordability of health care coverage. According to the Partnership to Fight Chronic Disease, since 2000, health insurance premiums for employer-sponsored family coverage have increased by 87 percent. Health care costs for people with a chronic condition average $6,032 annually – five times higher than for those without such a condition.

Nearly half (45 percent) of all Americans suffer from at least one chronic disease. More than two-thirds of all deaths are caused by one or more of five chronic diseases: heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes. More than one in four Americans have multiple chronic conditions, and evidence is growing that the presence of one chronic condition has a negative impact on the risk of developing others, particularly as people age. The nation’s aging population, coupled with existing risk factors (tobacco use, poor nutrition, lack of physical activity) and medical advances, lead to the conclusion that these problems are only going to grow if they are not effectively addressed now.

A recent Milken Institute analysis determined that treatment of the seven most common chronic diseases, coupled with productivity losses, will cost the U.S. economy more than $1 trillion annually. The same analysis estimates that modest reductions in unhealthy behaviors could prevent or delay 40 million cases of chronic illness per year.

As the American population ages and more people are categorized as “high risk” for multiple chronic diseases, it is important to recognize that an individual’s choices, as well as where they live, attend school, and work, have an impact. Risky behaviors such as poor diet, lack of physical activity, use of tobacco, and ignoring known risks, like family history, result in a dramatic increase in chronic conditions. While most people do not ignore their automobile’s “check engine light,” many routinely skip their own body’s preventive maintenance warnings; thus, making poor choices about their health. The result is a poor collective health quality in a country that spends much more on healthcare that anywhere else in the world.

State Public Health Chronic Disease Prevention and Control Programs, especially those that focus on critical, common risk factors (nutrition and physical activity, tobacco use) and related behaviors are a key link to improving our nation’s health. Programs focused on age groups (childhood obesity prevention, youth tobacco prevention, senior physical activity programs) are all needed to serve as an adjunct to clinical medicine. These programs provide the venues and opportunities to help make the healthy choice the natural choice and provide reinforcement for healthy messages provided in the course of clinical care. These programs are the difference between hearing “you should eat better and get more exercise” from one’s doctor once a year, and being in communities where healthy foods and opportunities for physical activity are the norm and part of one’s daily life. Mays and Smith noted in Health Affairs that a 10% increase in public health spending would yield a reduced mortality rate across all causes, as well as a greater reduction in heart disease, diabetes, and cancer.

Today, only a small fraction of the United States’ governmental healthcare investment supports prevention and health promotion. States are implementing diverse,  cost effective strategies that work for early detection of cancer, prevention and control of diabetes, reduction of heart disease, stroke and arthritis, and reduction of the disability associated with all of these conditions. The state success stories on NACDD’s website are just the beginning. A substantial investment in the CDC, State Health Departments, and other HHS agencies must be made for a real impact. The investment needs to be such that every state in America has a full complement of evidence-based programs to promote health and fight chronic disease, as well as the necessary resources to coordinate these programs with related activities (Medicaid, CHIP, Exchanges). These programs must include increased resources for every state to address:

• Coordination and leadership of categorical programs
• Early Detection of Cancer and Cancer Survivorship Services
• Diabetes Prevention and Control (including prevention of kidney disease)
• Heart Disease and Stroke Prevention
• Healthy Community Programs (ACHIEVE, REACH, others)
• Tobacco Prevention and Control
• Arthritis Prevention and Control
• School Health and Oral Health Programs
• Healthy Aging – including Alzheimer’s Disease
• Improving Physical Activity and Nutrition

Public health programs work to improve care, prevent disease, and prevent complications of disease. An investment in chronic disease prevention and control programs saves lives, improves quality of life and saves healthcare dollars.