Chronic disease tab hits a trillion

Seven diseases, many preventable, afflict about half of all Americans

WASHINGTON -- Chronic diseases cost the nation's economy at least $1 trillion a year in lost productivity, and the amount could jump to about $6 trillion by mid-century, according to a report released Tuesday.

That is in addition to the nearly $300 billion it costs to treat chronic disease among those not in nursing homes.

"By investing in good health, we can add billions of dollars in economic growth in the coming decades," said Ross DeVol, director of regional economics at the nonprofit Milken Institute and principal author of the report. "With moderate improvements in prevention and early intervention such as reducing the rate of obesity, the savings to the economy would be enormous."

The study looked at seven chronic diseases -- many of them preventable -- that afflict about half of all Americans: diabetes, hypertension, stroke, heart disease, pulmonary conditions (primarily bronchitis and emphysema), cancer and mental disorders.

In addition to the labor actually lost when chronically ill workers do not show up on the job, the report also estimated the productivity loss by ill workers who perform their jobs at a reduced level. It said the latter category produces losses several times worse than absenteeism.

The report said the economic costs could be altered dramatically if Americans pursued an "alternative path" by changing lifestyles to reduce obesity through better nutrition and exercise, reductions in smoking, more aggressive early detection of diseases and less invasive treatments.

Such an alternative path could reduce the number of projected illnesses by about 40 million cases and save an estimated $1.6 trillion cumulatively by 2023, it said.

Reducing obesity rates from about 23 percent of the population to 19 percent of the population in 10 years could reduce the number of illnesses by nearly 15 million, cut medical costs by about $60 billion and increase productivity by about $250 billion in 2023.

The 19 percent target was the level of obesity in 1998, DeVol said. Current projections estimate that obesity levels will reach 29 percent by 2023 if not checked.

"We felt that it was not an unlikely expectation that if there was a national concerted effort, we could get it down to where we were a decade ago," he said.

Reducing smoking rates from about 22 percent of the population to about 15 percent could reduce the number of illnesses by about 9 million, save $30 billion in treatment costs and increase productivity by nearly $80 billion, the report said.

That level was based on expected trends and historic data, DeVol said.

The report found widespread differences in health levels among the states. The unhealthiest states run from the northeast along the Appalachian Mountains and as far west as Arkansas and Oklahoma.

The healthiest states were in the mountain West, including Utah, Colorado, New Mexico and Arizona, and Alaska.

While many studies have focused on the high cost of treating chronic diseases, this study may be the first to look at the broader picture of chronic diseases on the nation's economy.

Ken Thorpe, the coalition's executive director and a chairman of the Department of Health Policy and Management at Emory University in Atlanta, said the report highlights the need for the United States to adopt a new model for delivering and paying for health care that stresses prevention and chronic disease management.