A report published today by the US Institute of Medicine (IOM) calls for an overhaul of the way public health departments conduct surveillance and treatment of chronic diseases ranging from arthritis to depression. The report, co-sponsored by the US Centers for Disease Control and Prevention (CDC) and the Arthritis Foundation, both based in Atlanta, warns that chronic disease, which accounts for three quarters of healthcare spending in the United States, is an overlooked crisis. The authors argue that the CDC can use funds more efficiently by expanding surveillance systems, integrating community health systems in schools and workplaces and prioritizing patient education.
The report, Living Well with Chronic Illness, focuses on nine chronic conditions. In addition to cancer and type 2 diabetes, diseases for which substantial public health initiatives already exist, it names mental illnesses such as dementia, post-traumatic stress disorder, schizophrenia and depression. Such diseases decrease the productivity and quality of life of millions of Americans, but public health departments do not adequately address such illnesses, the report argues, in part because surveillance systems fail to assess the needs of patients with chronic disease. For example, little information exists about how people with chronic illnesses such as arthritis access healthcare and what interventions are most effective at increasing their productivity and decreasing the cost of managing the disease.
“Historically, when infectious diseases were the dominant thing, that was what surveillance systems counted,” says Robert Wallace, a physician at the University of Iowa and the chairman of the committee that produced the report. “But now there are enormous numbers of people with chronic illnesses and not enough information about what is and is not working in the public health sphere.”
At the core of the report’s recommendations is a call for the CDC to enact policies that empower people to seek care for chronic diseases. Such policies could include integrating health services in schools and workplaces to encourage healthy lifestyle choices that can prevent or mitigate chronic illness. The report also stresses the importance of getting individuals into the healthcare system early and helping them navigate care options to avoid confusion and alienation.
John Klippel, president of the Arthritis Foundation, says the IOM’s decision to issue a report on chronic illness is timely, and he hopes the public pays attention. “I don’t know that the public quite recognizes the importance and magnitude of chronic illness,” he says. “The effects of these illnesses on lifestyle and quality of life are profound. We need to use resources better, but we also need to empower people to take control of their own care.”
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