Anusuya Chatterjee
Managing Economist, Research
Aging and Demographics and Education & Workforce Development and Health and Human Capital and Indexes & Rankings and Public Policy and Regional Economics
Dr. Anusuya Chatterjee is a managing economist at the Milken Institute. Her expertise is in measuring broad economic impacts of health- and longevity-related issues. She has led research efforts on some of the Institute's highest-profile publications, involving such topics as the economics of chronic disease prevention and management, obesity, economics...
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Reversing the trend in chronic disease: What works?
By: Anusuya Chatterjee
January 29, 2014
A problem plaguing the U.S. economy is one that likewise plagues our health: The rising prevalence of chronic disease.

Many of these diseases are preventable or can be managed well with modest changes in behavior. ThataEUR(TM)s a tall order, however, because the forces that keep us sedentary and fill our mouths with junk food are powerful. Furthermore, we canaEUR(TM)t stop the demographic tide that makes us an aging nation.

Most of us are aware that obesity, smoking, and high cholesterol are key risk factors for several chronic conditions. But how have we fared in our effort to control them? One way to look at this is to examine the gap, if any, between the actual prevalence of some of these diseases and projections from a few years back.

In our recent research publication aEURoeCheckup Time: Chronic Disease and Wellness in America,aEUR? we found that the prevalence of four out of five chronic diseases was higher in the 2008 to 2010 period than projections based on 2003 data. Except for heart disease, which recorded 2.29 million fewer cases than baseline projections, the ailments we followed reported substantially more cases. But heart disease prevalence was lower even than our optimistic projection, which assumed relatively slow growth of risk factors.

Differences between actual and projected cases 2008-2010 (annual average)


So, what accounted for the welcome surprise in the heart disease data? It could be based on many things, including changes in risk factors and improved technology and treatment. We think smoking is the key, however. That habit has a stronger link with heart disease than with any of the other conditions studied. Thanks largely to an aggressive smoking cessation movement across the United States, its prevalence among American adults was 19.3 percent in 2010, 0.65 percentage point lower than the baseline forecast. Like heart disease itself, the decline in smoking outpaced even our optimistic estimates.

Another risk factor, obesity, did not fare as well. The 2010 rate was 27.8 percent, 1 percentage point higher than baseline projections and 1.9 points higher than the optimistic scenario.

We hope that the report card embodied in aEURoeCheckup TimeaEUR? offers guidance for policymakers and influences AmericansaEUR(TM) behavior. Perhaps certain elements of what worked against smoking can inspire a campaign to fight obesity, despite the differences between these two serious health risks. It appears that taxes imposed on cigarette purchases acted as an additional deterrent to lighting up. Should we do the same with junk food, as Mexico has? Or is information and education the key?

We expect that public campaigns to control obesity, improve nutrition, and spur physical activity will bear fruit as the nation battles cancer, diabetes, heart disease, hypertension and stroke. Bioscientific research, health education, programs to modify risk behavior, and employer investments in wellness are strong complements to those efforts, but even this broad set of strategies is far from comprehensive.


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