Cleaveland: Managing illnesses is key to health

Cleaveland: Managing illnesses is key to health

November 3rd, 2011 in Life Entertainment

Health-care costs in America continue to increase at an unsustainable pace. Medically related costs consume more than 17 percent of our gross domestic product. For 2009, health-care spending averaged $8,100 for every resident of the United States. Health-related debt is a major factor in many personal bankruptcies.

For 2009, costs were unequally distributed across the population. Five percent of Americans accounted for almost half of the nation's consumption of health-related services. By contrast, the healthier half of the population was responsible for just 3 percent of health expenditures. Fifteen

percent of Americans had no health-related expenses for the year.

These findings, were summarized in a July 2011 report by the National Institute for Health Care Management.

Chronic conditions, especially those associated with obesity, were prominent drivers of costs as was age greater than 55 years.

Ten conditions accounted for the majority of health costs: heart disease, trauma, cancer, mental disorders, non-traumatic joint disease, emphysema and asthma, high blood pressure, diabetes, and disorders of blood fats. Many individuals coped with multiple disorders.

Because of the prominent role of obesity in undermining health, medical costs are predicted to increase sharply as the rate of obesity accelerates. In 2001, only Alabama had an obesity prevalence above 30 percent. In 2010, 12 states, including Tennessee, shared this unhealthy distinction. Up to one-third of adolescents in the South are overweight. Obesity in early life portends heart disease and diabetes in adult life. Consequently, a progressively larger proportion of the population will develop costly, chronic illnesses in coming decades.

Preventive strategies and coordinated care can slow this costly trend.

* Role of prevention. Vigorous promotion of healthy eating habits is crucial. Fast food restaurants should voluntarily display calorie and fat contents of all menu items to inform consumer choices. Healthy options should be increased, especially for children.

School districts should make healthful food in cafeterias a priority. In a tight economy, some school districts argue that healthy menus are unaffordable. Spending for nutritious food now avoids massive, disease-related expenditures later. Nutrition should be integrated into the curriculum beginning in elementary school. Physical activity should be a part of every school day.

* Role of coordinated care. Screening of high-risk populations will identify individuals who require regular, consistent follow-up to avoid disabling complications in later years.

Consider a 38-year-old male who is 30 pounds overweight. His blood pressure and blood sugar are at the upper limit of normal. His blood fat levels are elevated. He cannot simply be given advice to lose weight and instructions to return in a year for follow-up. Left alone, he risks drifting into adult-onset diabetes which, over time, will jeopardize his vision, kidney function, and circulation to his heart, brain, and extremities. His increased chances of developing high blood pressure and atherosclerosis further cloud his future.

He will benefit from a "medical home" where all of his complex health issues can be systematically addressed at one location instead of being bounced from one medical office to another. Dietary instruction can be reinforced during regularly scheduled visits. Targets for regulation of blood abnormalities can be established and therapy adjusted to achieve these goals. Risks can be progressively reduced. Problems can be promptly addressed. The man becomes a full-time partner in improving his shaky health.

These measures raise the likelihood that he can maintain his job and his independence. His family can avoid catastrophic health care costs. His health insurance premiums can be stabilized.

Multiple studies document substantial savings from carefully structured care for chronic conditions. Longer, richer lives represent the humane outcome of these strategies.

Contact Clif Cleaveland at