Chronic Disease Prevention & Health Equity:

The Key to Improving Life and Healthcare

The COVID-19 Chronic disease is the most pressing

pandemic has challenge impacting our national health
today.
exposed racial
Six in 10 Americans live with a chronic disease, the leading cause of
health death and disability across the U.S. and the leading driver of
disparities that healthcare costs.1 To meet this health crisis, chronic disease funding at
the Centers for Disease Control and Prevention (CDC) must be tripled.
have existed for This significant investment, when focused on chronic disease
years. prevention and advancing a National Health Equity Strategy, will save
lives and healthcare dollars, and improve quality of life for millions of
Americans.
Black, Spanish-speaking,
and Native American and Addressing and preventing chronic disease are necessary steps
Indigenous people face toward addressing racial justice issues. The impact of systemic racism
higher rates of chronic on our health has been laid bare by the progression of SARS-nCoV-2,
diseases, such as or the novel coronavirus (COVID-19). Black and Spanish-speaking
diabetes, heart disease, residents are three times as likely to contract COVID-19 and twice as
and cancer, are more likely to die from it.2 The COVID-19 pandemic exposed disparities that
likely to be uninsured, have existed for years. Black, Spanish-speaking, and Native American
and face barriers in and Indigenous people face higher rates of chronic diseases, such as
accessing and utilizing diabetes, heart disease, and cancer,3 are more likely to be uninsured,4
care. and face barriers in accessing and utilizing care.5 By committing
resources to prevent chronic disease, we will improve the health of our
The need to address nation and make progress toward our common goal of creating a more
chronic disease is equitable society.
urgent. In a typical year,
these conditions account A Deeper Look at Chronic Disease in the U.S.
for more than 90% of the
nation’s $3.5 trillion in The need to address chronic disease is urgent. In a typical year, these
annual healthcare costs conditions account for more than 90% of the nation’s $3.5 trillion in
– and much of this is annual healthcare costs – and much of this is preventable.6 Putting off
preventable. for tomorrow what can be solved today is costing us substantially. For
every $240 we spend toward chronic disease prevention now, we
For every $240 we spend could eliminate $1,000 spent on reactive healthcare in the future.
toward chronic disease
prevention now, we Concrete healthcare costs are only the tip of the iceberg; the hidden
could eliminate $1,000 costs of chronic disease paint an even more urgent picture.
spent on reactive Absenteeism (time taken off work due to illness or other reasons) and
healthcare in the future. presenteeism (attending work despite an illness that prevents full
functioning) in school and at work take a significant toll on family life,
the ability to plan for their future, and our global economic
competitiveness.7

Since 1988, the National Association of Chronic Disease Directors and its more than 7,000 Members
have worked to strengthen state-based leadership and expertise for chronic disease prevention and
control in all states, territories, and nationally. Learn more at chronicdisease.org.
 Chronic Disease Prevention & Health Equity:
The Key to Improving Life and Healthcare

Our refusal to invest in disease prevention

Unfortunately, is killing us, literally and economically,
as it is generating an annual loss of productivity
commonly said, worth nearly $1 trillion.8
health outcomes Almost every American family is adversely affected by chronic
are decided by diseases in one way or another, through the death of a loved one or
the shared battle against life-long illness, disability, or compromised
just five digits – quality of life. These burdens affect society not only through physical
disease but on the personal and community level, considering the
the zip code financial burden that comes with fighting chronic disease. 9
where you live. Yet, these burdens are not shared equally. Unfortunately, as it is
commonly said, health outcomes are decided by just five digits – the
Because of historically zip code where you live. Because of historically racist practices like
racist practices like redlining, the relationship between zip code and health outcomes is
redlining, the founded on segregation and inequality. A Black man living in a rural
relationship between zip community will live seven years less than a white man living in a city.
code and health
outcomes is founded on Black neighborhoods on the South Side of Chicago, just miles away
segregation and from their white counterparts, face higher uninsured rates, more limited
inequality. access to fresh, healthy food, and a life-expectancy gap of up to 30
years.10 Despite Spanish-speaking individuals typically living longer
Black neighborhoods on than their white counterparts in places like Long Beach, Calif.,
the South Side of predominantly Spanish-speaking communities have life expectancies
Chicago, just miles away five years shorter than adjacent, white neighborhoods. 11
from their white
counterparts, face higher Racial disparities cut across every facet of our healthcare system.
uninsured rates, more Black and Native American and Indigenous women are two to three
limited access to fresh, times more likely to die from pregnancy-related causes than white
healthy food, and a life- women.12 While white men are more likely to develop colorectal cancer
expectancy gap of up to than Black men and white women are more likely to develop breast
30 years. cancer than Black women,13 both Black men and women are more
likely to die from those diagnoses.
Racial disparities cut
across every facet of our Spanish-speaking individuals are 66% more likely than white people to
healthcare system. have diabetes14 and 2.6 times as likely to be hospitalized with end-
stage kidney disease related to diabetes.15

Black, Spanish-speaking, and American Indian and Alaska Native

people are more likely than white people to delay or go without needed
care.16 Black and Spanish-speaking adults are less likely than white
adults to have a usual source of care or to have had a health or dental
visit in the previous year.17

Since 1988, the National Association of Chronic Disease Directors and its more than 7,000 Members
have worked to strengthen state-based leadership and expertise for chronic disease prevention and
control in all states, territories, and nationally. Learn more at chronicdisease.org.
 Chronic Disease Prevention & Health Equity:
The Key to Improving Life and Healthcare

Sadly, these are but a few of the seemingly endless statistics that
Financially, racial health demonstrate the glaring health inequity faced by people of color across
disparities are the country.
associated with
substantial annual
economic losses in the The COVID-19 pandemic has unmasked the
U.S., including an effects of systemic racism on our health,
estimated $35 billion in highlighting the way poverty, poor housing,
excess healthcare
expenditures, $10 billion pollution, and food deserts, among other
in illness-related lost factors, combine to make Black, Spanish-
productivity, and nearly Speaking, and Native American and
$200 billion in premature
deaths. Indigenous communities more ill than
others.
Concerted efforts to
reduce health disparities The disproportionate rates of COVID-19 hospitalizations and deaths in
– in addition to Black, Spanish-speaking, and other non-white populations reflect the
addressing chronic disproportionate rate at which these groups suffer many chronic
disease as a whole – conditions.
would have immense
economic value. And the lack of response to their needs throughout this pandemic –
such as the fact that testing for Black and Spanish-speaking
Americans happens later in COVID-19 disease progression – is
evidence to the way our public health system fails to care for these
marginalized communities.

Financially, racial health disparities are associated with substantial

annual economic losses in the U.S., including an estimated $35 billion
in excess healthcare expenditures, $10 billion in illness-related lost
productivity, and nearly $200 billion in premature deaths.18 Concerted
efforts to reduce health disparities – in addition to addressing chronic
disease as a whole – would have immense economic value.

Trust for America’s Health recently reported that the return on

investment for public health prevention programs is 0.96:1 in years one
and two and 5.6:1 by year five.19 This means that, even in the initial
budget period, there would be a net gain by investing in prevention.

At a time when our investments in housing, education, and medical

care have outstripped inflation, our investment in chronic disease
prevention has lagged far behind.

Since 1988, the National Association of Chronic Disease Directors and its more than 7,000 Members
have worked to strengthen state-based leadership and expertise for chronic disease prevention and
control in all states, territories, and nationally. Learn more at chronicdisease.org.
 Chronic Disease Prevention & Health Equity:
The Key to Improving Life and Healthcare

Today, we fund prevention efforts at

At a time when approximately the same level we did in
our investments 2001, effectively a funding cut of 23%
in housing, when taking into account inflation.
education, and Public health programs improve care, prevent disease, and prevent
medical care complications of disease. Investing in chronic disease prevention and
control programs will pay off now, and in the future, by promoting the
have well-being of all Americans and addressing some of the most
egregious disparities that persist across the country.
outstripped
inflation, our Some of the statistics are shocking:
• As of 2014, 60% of American adults had at least one chronic
investment in condition, and 42% had more than one chronic condition.
chronic disease • Chronic diseases such as heart disease, cancer, and diabetes are
prevention has the leading causes of death and disability in the U.S. Seven in 10
leading causes of death in 2017 were chronic diseases, totaling
lagged far about 1.75 million American deaths.
behind.
• More than 90% of the nation’s healthcare costs relate to chronic
disease,20 and most of those costs are preventable.21
Today, we fund
prevention efforts at • The projected prevalence of any cardiovascular disease in the
approximately the same U.S. will increase by up to 45% by the year 2035.22
level we did in 2001,
effectively a funding cut • Risk factors such as poor diet, lack of activity, alcohol abuse, and
of 23% when taking into ignoring medical advice all contribute overwhelmingly to this crisis.
account inflation.
• Twenty-seven percent of young adults are too overweight to serve
Public health programs in the U.S. military.23
improve care, prevent
disease, and prevent • Every factor mentioned is multiplied when you add race or age to
complications of the equation.
disease.
On the other hand, investments in addressing chronic disease have
paid off. In fact, the CDC’s National Center for Chronic Disease
Prevention and Health Promotion (NCCDPHP) has made tangible
strides in improving health outcomes over the past 30 years:24

• From 2012 to 2018, 16.4 million smokers attempted to quit and 1

million successfully quit because of the CDC’s Tips campaign.

Since 1988, the National Association of Chronic Disease Directors and its more than 7,000 Members
have worked to strengthen state-based leadership and expertise for chronic disease prevention and
control in all states, territories, and nationally. Learn more at chronicdisease.org.
 Chronic Disease Prevention & Health Equity:
The Key to Improving Life and Healthcare

• From 2008 to 2018, the proportion of adults meeting aerobic

physical activity guidelines increased from 44% to 54%.
We have
• From 2008 to 2018, 26% fewer secondary schools across states
created a sold less nutritious snacks or beverages.
culture where
• Since 1991, the National Breast and Cervical Cancer Early
the healthy Detection Program has served more than 5.6 million women and
found 68,486 invasive breast cancers and 214,652 precancerous
choice is often cervical lesions.
the hardest
• The precent of adults who have their high blood pressure under
choice. control increased from 43.3% in 2005–2006 to 48.5% in 2015–
2016.
The CDC estimates that
reducing three risk Change is Overdue
factors – poor diet, lack
of physical activity, and We have created a culture where the healthy choice is often the
smoking – can prevent hardest choice. We know we need to choose healthier food options, be
80% of heart disease and more active, and avoid tobacco – yet, we continue to see recess and
stroke, 80% of type 2 physical education being cut from schools and tobacco products easily
diabetes, and 40% of accessible to children.
cancer.
The CDC estimates that reducing three risk factors – poor diet, lack of
Tripling chronic disease physical activity, and smoking – can prevent 80% of heart disease and
prevention funding at the stroke, 80% of type 2 diabetes, and 40% of cancer. Healthy food
CDC would finance options and safe opportunities to exercise certainly exist; however,
meaningful, evidenced- cost and location can make both seem like luxuries rather than
based programs that essentials.
address key chronic
health issues in every If there is to be a concerted effort to
state and territory. improve the lives of Americans, reduce
healthcare costs, reform the healthcare
system, and reduce health disparities,
there needs to be an equally concerted
investment in meaningful and equitable
prevention.
Tripling chronic disease prevention funding at the CDC would finance
meaningful, evidenced-based programs that address key chronic
health issues in every state and territory (see appended list**) while
supporting continued public health research to grow our body of
knowledge and combat the most pressing health disparities while we
transform our under-resourced public health system.

Since 1988, the National Association of Chronic Disease Directors and its more than 7,000 Members
have worked to strengthen state-based leadership and expertise for chronic disease prevention and
control in all states, territories, and nationally. Learn more at chronicdisease.org.
 Chronic Disease Prevention & Health Equity:
The Key to Improving Life and Healthcare

Program areas focused This would also allow for the continued study of the relationship
on chronic diseases between chronic diseases and risk for infectious disease like COVID-
and risk factors**: 19. Preventing and reducing chronic disease is a necessity to reduce
the adverse impacts of COVID-19 and to create a resilient population
• Diabetes in the face of future health threats.

• Heart disease This increased investment is needed for the upcoming fiscal year, with
an eye toward further budget growth in coming years. Increased
• Stroke funding would allow these essential programs to develop a presence in
every state across many communities.
• Cancer prevention
(multiple types), To encompass the focus on equity in addressing chronic disease, we
screening, registry urge you to change the name of the CDC center focused on these
issues to the National Center for Chronic Disease Prevention and
• Obesity Health Equity. Improving the public’s health means tackling racial
disparities head-on.
• Arthritis
This name change would reflect the core functions that disease
prevention, public health promotion, and remediating population-based
• Alzheimer’s disease
strategy have in supporting healthier children, a healthier workforce,
and healthier, longer lives for all Americans.
• Epilepsy

• Oral health The National Association of Chronic Disease

Directors25 stands ready to work with you
• Tobacco and the excellent team of professionals at
• Physical activity the CDC to accomplish this new reality.

• Health equity Questions to Author:

Dr. David Hoffman, Associate Dean of Academic Initiatives
• Reproductive health
and Government Affairs, Associate Professor of Ethics and
• Chronic disease Health Policy, Maria College; Clinical Professor, University
epidemiology of Albany School of Public Health; Adj. Asst. Professor
Albany Medical College Alden March Bioethics Institute;
• Workplace health [email protected]
promotion
*Dr. Hoffman is a long-time Board Member and Policy Chair
of NACDD.

Since 1988, the National Association of Chronic Disease Directors and its more than 7,000 Members
have worked to strengthen state-based leadership and expertise for chronic disease prevention and
control in all states, territories, and nationally. Learn more at chronicdisease.org.
 Chronic Disease Prevention & Health Equity:
The Key to Improving Life and Healthcare
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Since 1988, the National Association of Chronic Disease Directors and its more than 7,000 Members
have worked to strengthen state-based leadership and expertise for chronic disease prevention and
control in all states, territories, and nationally. Learn more at chronicdisease.org.