Health Care Facts: Prevention

Over the past century, the United States has made significant gains in treating illness and increasing life
expectancy. Despite these improvements, rates of chronic disease are higher in the U.S. than in any other
country—nearly half (45%) of Americans suffer from at least one chronic disease.1 Chronic diseases, such as
heart disease, diabetes, pulmonary disease, and cancer, are among the most costly and preventable diseases in the
United States.2, 3 Three out of every four health care dollars are spent treating chronic disease and seven out of ten
deaths are caused by chronic disease.4
Figure 1 : Avoidable Treatment Costs
At least one third of deaths in the United States are and Output Losses, 2023 7
attributable to a handful of unhealthy behaviors:
smoking, poor nutrition, and lack of physical
activity.5 Increasing our efforts to prevent and
manage disease has the potential not only to
improve the quality and length of life, but also to
decrease health care spending.

A study by the Milken Institute found that, if the U.S.

can make modest improvements in prevention and
management of disease by 2023, we could avoid 40
million cases of chronic disease and save $218
billion annually in treatment costs. Improved
productivity due to a decrease in chronic disease
could increase the GDP by $905 billion.6 (Figure 1) Sources: Figure taken from DeVol, Bedroussian, et al. (2007), Milken Institute
tabulations from MEPS, NHIS.

TOBACCO

Tobacco use is the number one cause of preventable death in the U.S.7 Smoking tobacco greatly increases
the risk of premature death, cancer, heart disease, and many other negative health consequences.8
• 18.4% of American adults currently smoke cigarettes.9
• Lung cancer is largely preventable, yet more people die from lung cancer than any other type of cancer.10
Smoking or exposure to secondhand smoke is the primary cause of eight out of ten lung cancer cases.11
• Every year 443,000 Americans die prematurely from tobacco related disease.12 In other words, tobacco is
responsible for almost one in five deaths in the United States.13
• The large majority of adult smokers began smoking before the age of 18 (nearly 80% by age 18 and nearly
90% by age 20).14 This suggests that preventing children from using tobacco could greatly reduce the
prevalence of tobacco use and its associated health consequences.
• People who quit smoking greatly reduce their risk of heart disease, lung and other cancers, respiratory
problems, poor birth outcomes for pregnant women, and premature death.15
• 70% of American adult smokers report that they want to quit, yet less than 5% a year succeed.16
• In 2008, only three states funded their tobacco prevention programs at the Center for Disease Control’s
minimum recommended level, and 30 states spent less than half of the minimum level. Total state spending
on tobacco prevention programs was less than 3% of the revenue generated from tobacco taxes and tobacco
industry settlements.17

National Coalition on Health Care August 2009

 OBESITY

Obesity is largely preventable and increases the risk

Figure 2: Percentage of Obese 19
Percentage of Obese American20Adults of many chronic conditions, such as heart disease,
American Adults
30 certain cancers, diabetes, high blood pressure, and
25
many other diseases.18
• Nearly two thirds of Americans are overweighti or
Percent Obese

20
obese.ii Currently, more than one quarter (26.7%) of
15
American adults are obese, compared to a prevalence
10 of 15.9% in 1995.19 (Figure 2)
5 • Over the past three decades, the prevalence of obese
0 children aged 6-19 has tripled.20 This is especially
1995 2001 2008 concerning considering that approximately 60% of
Year obese children already have at least one risk factor for
Source: BRFS heart disease21 and are very likely grow up to be obese
adults.22
• The Institute of Medicine estimated that children born in the United States in 2000 have a 30-40%
chance of developing Type 2 diabetes at some point in their lifetime. The lifetime risk of developing
Type 2 diabetes is even higher for racial and ethnic minorities.23
• Children from low-income households are more likely to be obese than children from higher income
households (17.8% of children living below 100% of Federal Poverty Line (FPL) versus 11.7% of
children living 400% and above FPL). Part of this disparity can be attributed to barriers that low-
income families face in accessing nutritious food, e.g. inadequate resources to purchase healthy foods
and few sources of healthy foods in their community.24
• Obesity disproportionately affects racial and ethnic minorities. Compared to an obesity rate of 23.7%
among Caucasians, over one third (35.7%) of African Americans and 28.7% of Hispanics are obese.25

COSTS

• In 2008, direct medical spending attributable to obesity was $147 billion—nearly double what was spent a
decade ago. Obesity related health conditions account for almost one in ten (9.1%) health care dollars,
compared to 6.1% of health care spending in 1998.26 These estimates do not include indirect costs such as
absenteeism and reduced worker productivity.
• Health care spending for an obese person is on average $1,429 higher per year (42% higher) than for a
person of normal weight.27
• During 2001-2004, the total economic burden of smoking was approximately $193 billion annually — $97
billion in spending for smoking-attributable health care and an additional $97 in lost productivity. By
contrast, state-based tobacco prevention and control programs only received $595 million in 2007 —
approximately 325 times less money than smoking-attributable costs.28
• According to the Trust for America’s Health, an annual investment of $10 per person in evidence-based
community prevention programs can yield significant cost savings. In five years, Medicare and Medicaid
alone could yield net savings of $7 billion annually, and total U.S. medical spending could be reduced by
$16 billion annually.29
This fact sheet was research and prepared by Julie Bromberg on 8/7/09.

i
Overweight is defined as a Body Mass Index (BMI) equal to or greater than 25.
ii
Obese is defined as a BMI greater than or equal to 30.
National Coalition on Health Care August 2009
 References
1
Kott A, Fruh D, Cameron L, Greger C, Klein K, Lethert C, et al. “2009 Almanac of Chronic Disease: Impact of Chronic
Disease on U.S. Health and Prosperity: A Collection of Statistics and Commentary.” Partnership to Fight Chronic Disease.
2009. Available at: http://www.fightchronicdisease.org/pdfs/2009_PFCDAlmanac.pdf
2
Centers for Disease Control. “Chronic Disease Overview” [Fact Sheet]. March 2008. Available at:
http://www.cdc.gov/nccdphp/overview.htm
3
Woolf, SH. “The Big Answer: Rediscovering Prevention at a Time of Crisis in Health Care.” Harvard Health Policy Review,
7(2): 5-20. Fall 2006.
4
Kott A, Fruh D, Cameron L, Greger C, Klein K, Lethert C, et al. “2009 Almanac of Chronic Disease: Impact of Chronic
Disease on U.S. Health and Prosperity: A Collection of Statistics and Commentary.” Partnership to Fight Chronic Disease.
2009. Available at: http://www.fightchronicdisease.org/pdfs/2009_PFCDAlmanac.pdf
5
Mokdad AH, Marks JS, Stroup DF, and Gerberding JL. “Actual Causes of Death in the United States, 2000,” JAMA, 291:
1238-1245. 2004.
6
DeVol R, Bedroussian A, et al. “An Unhealthy America: The Economic Burden of Chronic Disease.” Santa Monica, CA: The
Milken Institute. October 2007. Available at: http://www.milkeninstitute.org/pdf/ES_ResearchFindings.pdf
7
Centers for Disease Control. “Cigarette Smoking Among Adults—United States 2006.” Morbidity and Mortality Weekly
Review. 56(44);1157-1161. November 9, 2007. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5644a2.htm
8
Centers for Disease Control. “Smoking and Tobacco Use: Health Effects of Cigarette Smoking” [Fact Sheet]. May 2009.
Available at: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm
9
Centers for Disease Control, Behavioral Risk Factor Surveillance System. Nationwide Tobacco Use [Data Set]. Accessed:
July 23, 2009. Available at: http://apps.nccd.cdc.gov/brfss/
10
American Cancer Society. “Cancer Facts and Figures 2009.” Atlanta: American Cancer Society. 2009. Available at:
http://www.cancer.org/downloads/STT/500809web.pdf
11
Centers for Disease Control. “The Health Consequences of Smoking: A Report of the Surgeon General.” Atlanta, GA: U.S.
Department of Health and Human Services. 2004. Available from:
http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2004/index.htm
12
Centers for Disease Control. “Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—
United States, 2000–2004.” Morbidity and Mortality Weekly Report, 57(45):1226–1228. Nov 14, 2008.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htm
13
Tejada-Vera B, Sutton PD. “Births, Marriages, Divorces, and Deaths: Provisional Data for October 2008.” National Vital
Statistics Reports, 57(17). Hyattsville, MD: National Center for Health Statistics. June 26, 2009. Available at:
http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_17.pdf
14
American Legacy Foundation. “Fact Clipboard” [Fact Sheet]. Calculated based on data in Substance Abuse and Mental
Health Services Administration (SAMHSA), Results from the 2006 National Survey on Drug Use and Health (NSDUH), 2007.
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of
Applied Studies. Available at: http://www.americanlegacy.org/factsheets.aspx
15
Centers for Disease Control. “Smoking and Tobacco Use: Health Effects of Cigarette Smoking” [Fact Sheet]. May 2009.
Available at: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm
16
Centers for Disease Control. “Cigarette Smoking Among Adults—United States 2006.” Morbidity and Mortality Weekly
Review. 56(44);1157-1161. November 9, 2007. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5644a2.htm
17
Campaign for Tobacco Free Kids. “A Broken Promise to Our Children: The 1998 State Tobacco Settlement Nine Years
Later.” Washington, DC: Campaign for Tobacco Free Kids. Dec 2007. Available at:
http://tobaccofreekids.org/reports/settlements/2008/fullreport.pdf
18
Centers for Disease Control. “Overweight and Obesity: Health Consequences” [Fact Sheet]. May 2009. Available at:
http://www.cdc.gov/obesity/causes/health.html
19
Centers for Disease Control, Behavioral Risk Factor Surveillance System. Nationwide Tobacco Use [Data Set]. Accessed:
July 23, 2009. Available at: http://apps.nccd.cdc.gov/brfss/
20
Centers for Disease Control, “Overweight and Obesity: Childhood Overweight and Obesity.” May 2009. Available at:
http://www.cdc.gov/obesity/childhood/index.html
21
Institute of Medicine. “Preventing Childhood Obesity: Health in the Balance” [Fact Sheet]. Washington, DC: National
Academies Press. Sept 2004. Available at: http://www.iom.edu/Object.File/Master/22/606/FINALfactsandfigures2.pdf
22
Centers for Disease Control, “Overweight and Obesity: Childhood Overweight and Obesity.” May 2009. Available at:
http://www.cdc.gov/obesity/childhood/index.html
23
Institute of Medicine. “Preventing Childhood Obesity: Health in the Balance” [Fact Sheet]. Washington, DC: National
Academies Press. Sept 2004. Available at: http://www.iom.edu/Object.File/Master/22/606/FINALfactsandfigures2.pdf
24
Robert Wood Johnson Foundation on Commission to Build a Healthier America. “Beyond Health Care: New Directions to a
Healthier America.” Robert Wood Johnson Foundation. April 2009. Available at:
http://www.rwjf.org/files/research/commission2009finalreport.pdf

National Coalition on Health Care August 2009

 25
Pan L, Galuska DA, Sherry B, Hunter AS, Rutledge GE, Dietz WH, and Balluz LS. Centers for Disease Control, National
Center for Chronic Disease Prevention and Health Promotion. “Differences in Prevalence of Obesity Among Black, White,
and Hispanic Adults --- United States, 2006—2008.” Morbidity and Mortality Weekly Review, 58(27);740-744. July 17, 2009.
Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5827a2.htm
26
Finkelstein EA, Trogdon JG, Cohen JW, and Dietz W. “Annual Medical Spending Attributable To Obesity: Payer- And
Service-Specific Estimates.” Health Affairs 28(5): w822-w831. July 27, 2009. Available at:
http://content.healthaffairs.org/cgi/content/full/hlthaff.28.5.w822/DC1
27
Ibid.
28
Campaign for Tobacco Free Kids. “A Broken Promise to Our Children: The 1998 State Tobacco Settlement Nine Years
Later.” Washington, DC: Campaign for Tobacco Free Kids. Dec 2007. Available at:
http://tobaccofreekids.org/reports/settlements/2008/fullreport.pdf
29
Levi J, Segal LM, Juliane C, et al. “Prevention for a Healthier America.” Washington, DC: Trust for America’s Health. July
2008. Available at: http://healthyamericans.org/reports/prevention08/Prevention08.pdf

National Coalition on Health Care August 2009