Panel
Reducing the Health and Economic Burden of Chronic Disease
Milken InstituteBill Dietz, Jim, Stefano Bertozzi, ERIC SCHMIDT, ELLEN MULLENFELDTNER, JOHN MCDONOUGH JR., JOHN MCCORD JR., ERIC SCHWARTZMANN, FRIDA L., COREY, Alice Waters
- Chronic disease spending is projected to grow as an increasing percentage of total healthcare costs, with obesity currently associated with 12% to 13% of total medical costs and expected to drive a global expansion in chronic disease scope.
- Obesity prevalence trends indicate a continued increase among women and a potential flattening among men, with approximately 20% of the 20- to 39-year-old age group expected to gain 20 kilos or 45 pounds; specific demographics include higher risks of excessive weight gain for African American women and a 50% risk reduction for pre-diabetics who lose 5% of body weight.
- Pediatric obesity metrics show a decrease in children aged 2 to 5 within general and WIC populations, while prevalence for 6- to 11-year-olds has remained flat for the last decade; future goals include breaking the historical 30-year window between medical insight and implementation.
- Regional health crises are escalating, with diabetes projected to remain the top cause of morbidity and mortality in Mexico and fatty liver expected to become the primary cause of liver transplants in Los Angeles, particularly affecting the Latino population through genetic predispositions linked to sugar intake and obesity.
- Cancer care objectives are shifting toward maintaining quality of life alongside survival, addressing significant gaps in patient-reported outcomes for survivorship and recognizing that obesity remains a risk factor for cancer recurrence.
- Strategic solutions emphasize the need for scalable, simple, cost-effective, and free evidence-based programs, including the "Real Appeal" virtual initiative which targets enrollment of over 300,000 insured members and integrates clinical with community services to overcome environmental barriers like lack of walkability or access to healthy foods.
- Policy approaches focus on the growth of excise taxes on sugar-sweetened beverages, with new implementations planned in Berkeley, San Francisco, Albany, Cook County, Oakland, Philadelphia, and Boulder, while a national soda tax is deemed unlikely; tobacco excise taxes are scheduled for 2018 in France, Hungary, Ireland, Norway, South Africa, and the United Kingdom.
- Digital health technologies, particularly FDA-approved devices and low-tech EMT house calls, are expected to transform disease management, with asthma cited as a prime success area and EMT interventions projected to have an 80% acceptance rate and generate massive system savings.
- Data sharing and interoperability are anticipated to see real breakthroughs within the next five to six years, potentially driven by high voluntary consent rates among Kaiser's 11.5 million patients, though current systems lack the ability to revert to patient interventions without explicit consent.
- Significant knowledge gaps persist among providers, with less than 50% aware of basic physical activity recommendations and only 16% recognizing that various diet types can work for obesity, necessitating a combination of top-down legislative and bottom-up data-enabled models.
- Public awareness deficits are evident, with only 25% of Americans knowing HDL is "good" cholesterol, 28% knowing heart disease is the primary killer of diabetics, and clinicians lacking preparation for deploying advanced "Star Wars" technology solutions.
- Smoking cessation faces challenges with decreasing rates in some areas and a 25-year earlier mortality risk for the mentally ill population, while the tobacco industry remains active in developing nations and concentrated special populations within the developed world.
- Mental health is recognized as a chronic disease with slow progress over the last 20 years, though improved biological definitions and early intervention strategies for trauma are creating opportunities for scalable programs to be developed further.
- Corporate involvement is expected to play a major role in educating employees and reducing costs, leveraging the high community engagement desire among millennial workers to drive health outcomes.