Discussion Question #2

In the United States, healthcare spending has reached an all-time high, surpassing all developed nations in healthcare spending, in 2017 the cost of healthcare reached over $3.5 trillion or $10,739 per person (Hellmann, 2018). Costs are expected to rise each year with no slowdown in sight. Many of the major causes of health concerns in the US can be attributed to preventable diseases that stem from lifestyle aspects and health behaviors. More than 75% of costs are due to chronic conditions (National Health Council, 2014). The pattern of healthcare costs combined with an increased death rate among those with chronic diseases calls for a solution to help stem the number of people with chronic diseases. A resolution exists between the private healthcare system and governmental agencies.

Preventable chronic diseases are defined as ongoing, generally incurable illnesses or conditions, such as heart disease, asthma, cancer, and diabetes. These diseases are often preventable, and frequently manageable through early detection, improved diet, exercise, and treatment therapy (Fight Chronic Disease, 2010).  Many of these diseases stem from behavioral factors, such as tobacco use, alcohol abuse, sedentary lifestyle, and poor nutrition. Healthy diet and exercise are essential to the health of a population. A sedentary lifestyle is linked to obesity, which causes varied health risks, from heart disease and diabetes to anxiety and depression (Kerns, Dee et al., 2014). Poor nutrition adds to the risk of obesity and increases the likelihood of developing health preventable risks.  Twenty-five chronic disease and condition codes in the International Classification of Disease (ICD)-10 are entirely attributable to alcohol, and alcohol plays a component-risk role in certain cancers, other tumors, neuropsychiatric conditions, and numerous cardiovascular and digestive diseases (Shield, Parry, and Rehm, 2013). These behavioral factors and subsequent chronic diseases add to the growing cost of health care.

Health behavior, genetics, and other health determinants affect an individuals susceptibility to these preventable chronic diseases. Social determinants of health are defined as circumstances in which people are born, grow up, live, for, and age, and the systems in place to address an illness that is, in turn, shaped by larger forces, including economics, social policies, and politics (Jonas, Knickman, et al., 2015).  Based on these determinants, low-income areas are linked to poor nutrition and diet, a sedentary lifestyle, and tobacco use. Access to healthy food and adequate nutrition is one of the key factors affecting those in the lower income bracket, in 2016 15.6 million households were food insecure (Diaz, 2018). Food deserts, consisting of a high density of fast food establishments and convince stores, which contribute to poor nutrition, and an inadequate diet, adding to the obesity epidemic. In the U.S, people living below the poverty level and people having lower levels of educational attainment have higher rates of cigarette smoking than the general population (CDC, 2014). Use of tobacco products are known to cause cancer, high blood pressure and heart disease. In recent decades, affluent populations have become increasingly sedentary, with many adults spending 70% or more of their waking hours sitting (Owen, Sparling, Healy, et al. 2010). A sedentary lifestyle has linked an increase in obesity, with increased risks of type 2 diabetes, cardiovascular disease (CVD) and cardiovascular risk factors, respiratory diseases such as asthma, musculoskeletal disorders such as osteoarthritis and lower back pain, several cancers, and depression (WHO, 2002).  Alcohol abuses are varied across economic backgrounds, while stress has been found to be a risk factor to alcohol abuse. Alcohol abuse is one of the leading risk factors of death and disease in the US (Shute, 2015).

The cost of chronic disease is undoubtedly high, chronic diseases require constant monitoring and adequate medications to prevent further deterioration of health. The United States spends more per capita than any other nation on health care, 90% of the $3.3 trillion, in medical costs associated with chronic diseases such as diabetes, heart disease, and cancer, diseases that have a direct link to smoking and obesity, the nation’s two largest national risk factors (CDC,2019). Diabetes, among one the leading preventable chronic disease in the US, costs the healthcare system and employers $237 billion every year (CDC,2019). Obesity affects almost 1 in 5 children and 1 in 3 adults, putting people at risk for chronic diseases such as diabetes, heart disease, and some cancers. Obesity costs the US health care system $147 billion a year (CDC,2019). While tobacco use accounted for a total economic cost of more than $300 billion a year in the US (Hall and Dornan, 2016).  One of the most prominent behavioral factors in the health care today, a sedentary lifestyle accounts for $117 billion in health care costs (CDC,2019). Alcohol abuse resulted in a cost of $249 billion to the US economy (CDC, 2019).  While these costs are astronomical compared to other developed countries, they can be prevented with early intervention and lifestyle changes.

High costs of healthcare have been a topic of discussion for over a decade now, the argument surrounding the costs has moved two steps forward one step back, who will pay for these increased costs, what can be done with the current system? The high costs of preventable chronic diseases not only affects patients, and taxpayers but it also affects employers and insurance agencies. The rise in chronic diseases accounts for millions lost in productivity, along with increased issuance premiums. One solution that has sprouted between employers and insurance agencies is rewarding healthy behaviors. Apple and Aetna have teamed up and created an app that uses an individuals health history to set healthy goals to achieve a healthier lifestyle, incentivizing these goals with gift cards and apple watches to encourage continued changes. This program may help encourage a more active lifestyle and a change in the individuals family as well. Similar programs have been implemented in various companies offering bonus and or time off for reaching health goals. This change can help reduce costs to all parties, the insurer, employer and employee through reduced deductibles and medical interventions. The private agencies are best positioned to make these changes among their employees and their families.

While a solution based on employers may work for those in corporate positions or have employers that offer health care, it is not the most effective solution to the health disparities among those in low socioeconomic areas. Changes to lower-income areas that do not have access to affordable nutritious foods, green spaces for exercise or adequate health care should be addressed by local planning departments in conjunction with the health department. The planning department should zone areas dedicated to safe outdoor spaces where residents can exercise. Local health departments can offer basic health checks in conjunction with non-profit organizations to monitor and provide low cost interventions to stem the development of chronic diseases. School boards should look into providing fresh food to reduce the number of children at risk or who are obese. These solutions are better said than done. Financial costs and the reduced budgets of local governments hinder many programs.

It is hard to believe that 90% of the $3.3 trillion we spend on health care is on preventable causes. Health issues such as a sedentary lifestyle, tobacco use, alcohol abuse, and unhealthy diets can be changed.  We can use policies to catalyze the health of our communities, bring about cost-saving measures that benefit the people and the government.  For example, policies requiring tobacco companies to place a warning on packaging and using marketing strategies to warn the public of the dangers of smoking have worked in reducing the number of new smokers and aiding those who want to quit. Safe areas for communities to engage in physical activity should be established in each community. Providing access to yearly health checks and basic preventive medications should be made affordable to all populations. Resolutions such as employer and insurer guided health changes have made changes in some areas, using these small changes to impact the health of the individual and their family is a great way to reduce costs for all involved. There are many factors that have led to the current cost burden of health care but there are also many solutions to help decrease spending and increase the health of the population overall.

References

• Center, F. (2009, November 20). Preventable Diseases Costing U.S. Billions, Report Finds. Retrieved February 24, 2019, from https://philanthropynewsdigest.org/news/preventable-diseases-costing-u.s.-billions-report-finds
• Cigarette Smoking and Tobacco Use Among People of Low Socioeconomic Status | CDC. (2018, March 7). Retrieved February 24, 2019, from https://www.cdc.gov/tobacco/disparities/low-ses/index.htm
• Diaz, S. (2018, February 22). The Effects of Food Insecurity on Health Outcomes and Costs. Retrieved February 24, 2019, from https://www.healthify.us/healthify-insights/the-effects-of-food-insecurity-on-health-outcomes-and-costs
• Hellmann, J. (2018, December 06). US health-care spending topped $10,739 per person in 2017: Report. Retrieved February 24, 2019, from https://thehill.com/policy/healthcare/420144-health-care-spending-topped-10739-per-person-in-2017-report
• Jonas, S., Knickman, J., & Elbel, B. (2019). Jonas & Kovners health care delivery in the United States. New York, NY: Springer Publishing Company, LLC.
• National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). (2019, February 11). Retrieved February 24, 2019, from https://www.cdc.gov/chronicdisease/about/costs/index.htm
• National Health Council. (2014, July 13). Retrieved February 24, 2019, from https://www.nationalhealthcouncil.org/sites/default/files/NHC_Files/Pdf_Files/AboutChronicDisease.pdf
• NationalHealthAccountsHistorical. (2018, December 11). Retrieved February 24, 2019, from https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountshistorical.html
• Shield, K., MHc, Parry, C., PhD, & Rehm, J., PhD. (October 11). Focus On: Chronic Diseases and Conditions Related to Alcohol Use. Retrieved February 24, 2019, from https://pubs.niaaa.nih.gov/publications/arcr352/155-173.htm
• Shute, N. (2015, March 17). Your Drinking Habits May Be Influenced By How Much You Make. Retrieved February 24, 2019, from https://www.npr.org/sections/health-shots/2015/03/17/393554628/income-affects-how-genes-play-a-role-in-drinking-problems
• The Cost of Diabetes. (2019, January 30). Retrieved February 24, 2019, from http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html
• The Growing Crisis of Chronic Disease in the United States. (2014, September 25). Retrieved February 24, 2019, from https://www.fightchronicdisease.org/sites/default/files/docs/GrowingCrisisofChronicDiseaseintheUSfactsheet_81009.pdf