Earlier this month, the Milken Institute released a report on the economic burden of chronic disease in America. The report considers the health care and financial effects of cancer, diabetes, high blood pressure, stroke, heart disease, pulmonary conditions, and mental disorders. The report adds to the growing base of information describing the impact of chronic disease on health care costs and provides detailed analysis about its influence on the labor supply and the economy through decreased worker productivity.

What is most striking and troubling is that Massachusetts ranks in the lowest quartile of states—at 40th overall. According to the Milken report, Massachusetts’ chronic disease ranking is attributable to high cancer rates and the high incidence of alcohol abuse and other mental disorders.

The ranking is surprising because Massachusetts is generally viewed as one of the healthiest states in the nation. We rank first among states in terms of the overall rates of obesity — 19% of all Massachusetts residents are obese, compared to 30% of residents of Mississippi, which ranks last. But, at the same time, we rank 27th in the percent of children who are obese.

Obese children tend to become obese adults. Twenty percent of cancers in women and 15% of cancers in men are linked to obesity, which is also driving the increase in diabetes among adults and children. Obesity and diabetes are also associated with high blood pressure and heart disease. Obese workers have 21% higher health care costs than non-obese workers do.

By reversing the chronic disease trend here in Massachusetts, we can save billions of dollars in avoidable health care costs and on the indirect economic impact. Prevention and public health are critical components to reducing the prevalence of chronic disease and the cost of medical care.

We know that 80% of health care expenditures are consumed by just 20% of the population that has high health care needs. Treatments spent on some of these individuals are clearly beneficial; advances in therapies and treatment for chronic conditions like high blood pressure, heart disease and diabetes have lead to decreased disability, higher quality of life and lower mortality. In just the last decade, we have learned a tremendous amount about how to deliver high quality care to individuals with these chronic diseases and how to prevent complications.

We can do more to manage these conditions and deliver better care to individuals, but we also need to focus our efforts and resources on prevention. We can save far more money by preventing people from developing chronic diseases and becoming high consumers of health care than we will by trying to manage the cost of care for those who are already high consumers.

Public health campaigns to decrease smoking and educate people about the impact of second-hand smoke have been very effective, and that model should be used to address problems. For example, we must examine public policies that dictate the use and abuse of alcohol in order to decrease underage and binge among Massachusetts residents. Community-based initiatives that promote healthy eating and physical activity; collaborative initiatives between developers and public health officials to ensure a healthy built environment; school and workplace initiatives to promote healthy students and workers are all investments that will pay dividends over the long term.

Health and Human Services Secretary JudyAnn Bigby, M.D.

This program aired on October 19, 2007. The audio for this program is not available.

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Martha Bebinger Reporter
Martha Bebinger covers health care and other general assignments for WBUR.



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