Current Issues/Challenges in CD Control/Prevention

Question 1

What are 5 details about the epidemiological transition?

Answer 1

In the first quarter of the 20th century, major public health advances transformed communities and initiated a remarkable increase in life expectancy for Americans

At the same time, the distribution and demographic
composition of the American population was undergoing a major shift, growing rapidly and becoming more urban, older, and more diverse

Nearly a century ago, an epidemiologic transition, instigated in part by advances in public health, resulted in heart disease becoming the leading cause of death by 1933, overtaking infectious causes

Although heart disease remains the leading cause of death in the first quarter of the 21st century, incidence, prevalence, and mortality rates of heart disease have declined dramatically

As was the case a century earlier, these changes in the
distribution of diseases are driven in part by public health and health care improvements across the nation

Question 2

What are 4 details about the goals of chronic disease prevention and control?

Answer 2

The goals of chronic disease prevention and control are to improve health, life expectancy, and quality of life, so people live longer, healthier lives, free of disability, with final morbidity, if it occurs, compressed into a very brief
period of time before death

Such improvements would off-load considerable burden from the health care delivery system, reducing both utilization and costs of health care services

However, there is currently a substantial burden of disease requiring medical intervention, and many health care services that work effectively to
prevent and control chronic diseases

Thus, parallel goals, advanced in partnership with the health care system, are to (1) increase the effective delivery of quality clinical preventive, management, and treatment services; (2) reduce the costs of health care delivery; and (3) improve population health

Question 2

What are 2 details about the levels of prevention (defining chronic disease prevention and control)?

Answer 2

Primary prevention, secondary prevention, and tertiary prevention are based on the populations targeted by the interventions (healthy people, those with
risk factors, asymptomatic people with adverse biologic changes, and those with frank disease, respectively)

Strategies to prevent and control chronic disease fall into a four-part domain framework (epidemiology and surveillance, environmental approaches, health systems interventions, and linking community and clinical services)

Question 3

What are 4 details about the priorities and strategies for chronic disease prevention?

Answer 3

Chronic diseases have major negative effects on morbidity, mortality, and quality of life, and yet they can be prevented or delayed and their effects ameliorated at every stage with simple, cost-effective strategies and interventions

Although some gains can be realized quickly, chronic disease prevention and control generally take time and a persistent, long-term approach

The British epidemiologist Geoffrey Rose contrasted general population wide and high-risk approaches to disease prevention

The former attempts to move the distribution of risk factors to healthier levels in the whole population whereas the latter attempts to reduce risk among the most affected

Question 4

What are 3 details about information and translations gaps?

Answer 4

There are many remaining knowledge gaps that need to be filled to allow more and faster progress toward preventing and controlling chronic disease

For example, there remain many important knowledge gaps impeding progress in promoting physical activity, improving diets, and reducing obesity

On the other hand, many chronic disease areas such as tobacco-use prevention and cardiovascular disease prevention and control have numerous known effective interventions that are inadequately resourced
(e.g., state tobacco funding relative to CDC-recommended levels) or inadequately delivered (e.g., effective clinical and community prevention for cardiovascular disease such as hypertension and cholesterol control is under-delivered)

Question 5

What are 3 details about reach and impact?

Answer 5

Even the most effective public health efforts and programs fail to reach many people who could benefit from them

Examples include the more than 50% of the population who are still not covered by comprehensive smoke-free air laws , the still small numbers of the 86 million Americans with prediabetes who are currently reached by the Diabetes Prevention Program, and the 23.5 million people who have been estimated to live in food deserts

Better coordination of public health programs is likely to help improve reach and efficiency

Question 6

What are 4 details about disparities?

Answer 6

Death and disability rates remain elevated among socioeconomically disadvantaged populations, for some racial and ethnic populations (particularly African Americans, Hispanics, and American Indians), and vary widely by geographic location

Multicomponent approaches—that reach people in different settings, from different vantage points, and with different messages, all converging on the same health problem—are generally most effective

Often, these will include whole-population and targeted strategies to increase the likelihood that as jurisdiction-wide trends improve, gaps between individuals based on race/ethnicity, gender, geography, and other factors actually narrow simultaneously

For example, tobacco-control policies that increase price, reduce exposure to secondhand smoke, provide support for cessation services, and educate the population on the dangers and consequences of tobacco use all work together to reduce tobacco use and are effective in a variety of populations, with intensive interventions as appropriate in particular
jurisdictions or with particular populations

Question 7

What are 5 details about global health and chronic disease?

Answer 7

Rising Burden: Chronic diseases, including cardiovascular diseases, diabetes, cancer, and chronic
respiratory diseases, account for more than 70% of deaths globally, posing a significant public health challenge

Disproportionate Impact: Low- and middle-income countries bear the highest burden of chronic diseases, accounting for over 75% of global deaths from non-communicable diseases (NCDs), often due to limited healthcare resources and preventive measures

Shared Risk Factors: Common modifiable risk factors for chronic diseases include unhealthy diets, physical inactivity, tobacco use, and excessive alcohol consumption, which are prevalent worldwide

Economic Impact: Chronic diseases impose a substantial economic burden on healthcare systems and productivity, particularly in resource-constrained settings where healthcare access is limited

Inequities in Care: There are significant disparities in access to care for chronic diseases, with marginalized and economically disadvantaged populations facing barriers to diagnosis, treatment, and ongoing management

Question 8

What are 6 details about health systems and chronic disease management?

Answer 8

Health care systems in the United States often lacked a unified approach to prevent and manage chronic disease

People with multiple or complex chronic conditions have more complicated health needs, including frequent monitoring and evaluation, and multiple care providers across different health
environments

As an individual’s number of chronic conditions increases, that individual’s risk for dying, incurring avoidable hospitalizations, and experiencing poor day-to-day functioning also rise

In addition, these conditions contribute to frailty and disability, which often complicate access to health care, interfere with self-management, and necessitate reliance on caregivers

Many chronic diseases act synergistically, such as diabetes and depression, compounding the risk for poor
outcomes

These extra layers of complexity bring with them more challenges and costs to caring for chronic disease populations

Question 9

What are 8 details about workforce and training?

Answer 9

Funding Constraints: Insufficient and inconsistent funding for public health programs hinders recruitment,
training, and retention efforts. Public health is often underfunded compared to healthcare services, leaving gaps in workforce development

Low Compensation: Public health professionals often receive lower salaries compared to counterparts in other sectors, making it difficult to attract and retain talent

Workforce Burnout: The high demands of public health crises, such as COVID-19, lead to stress, burnout, and
early departure from the field

Geographic Disparities: Public health workforce shortages are often more severe in rural and underserved areas due to fewer training facilities and limited job incentives

Public Perception: Misunderstandings about the role and importance of public health reduce interest in the
field among potential recruits.

Technological Gaps: Inadequate access to modern tools and technologies deters new professionals who
expect to work with up-to-date resources

Political and Policy Challenges: Political resistance to public health measures and shifting policies can undermine morale and discourage new professionals from entering the field

Diversity and Inclusion Gaps: A lack of targeted efforts to recruit and support underrepresented groups limits workforce diversity, reducing cultural competence in addressing health disparities

Question 10

What are 3 details about provider payment reform?

Answer 10

CMS Innovation Center is also testing a payment approach known as bundled payment—a single reimbursement for all of the services required for a given medical condition or procedure (e.g., physician, hospital, or post-acute services)

Ideally, this should incentivize the various providers
involved in a given patient’s care to collaborate and strive for efficient and effective outcomes, including prevention of complications and disease progression

As of 2015, nearly 7,000 organizations have signed up to participate in bundled-payment demonstrations, which represent a further step toward shared accountability for quality and costs of health care delivery

Question 11

What are 6 details about health care reform: incentives for improved chronic disease control and prevention?

Answer 11

Centers for Medicare and Medicaid Services Innovation Center: the ACA created a number of new resources to establish a foundation for accelerated public- and private-sector innovation in health care delivery. One example is the Centers for Medicare and Medicaid Services (CMS) Innovation Center

This center was established to identify, test, and spread new payment and service delivery models to reduce expenditures while maintaining or improving quality of care for beneficiaries of Medicare, Medicaid, and the
Children’s Health Insurance Program

Accountable Care Organizations: an ACO is an entity formed by health care providers across various practice settings who agree to collectively take responsibility for the quality and total costs of care for a population of patients

Beginning in 2012, the ACA established the Medicare Shared Savings Program to encourage the development of ACOs

If participating ACOs meet quality benchmarks, such
as with diabetes care or depression screening, and keep spending for their attributed patients below budget, they receive half the savings that result, with the rest going to the CMS, which administers the program

Effective chronic disease care and prevention is a cornerstone to achieving benchmarks and realizing cost savings within an ACO structure

Question 12

What are the 3 levels of involvement for health care systems in chronic disease prevention and control?

Answer 12

Level 1: chronic disease management (the chronic care model)

Level 2: chronic disease screening approaches

Level 3: chronic disease prevention and health promotion

Question 13

What are 5 details about chronic disease screening approaches (level 2)?

Answer 13

Population-Based Screening:
Conducted on a large scale to identify risk factors in the general population (e.g., hypertension, diabetes).
Examples: Blood pressure checks, cholesterol tests, HbA1c for diabetes

Targeted Screening:
Focused on high-risk groups based on demographics, family history, or predisposing conditions
Examples: Mammograms for breast cancer in women over 40, colonoscopies for individuals over 50

Opportunistic Screening:
Conducted during routine healthcare visits for unrelated reasons
Example: Measuring BMI during a wellness check-up.

Community-Based Screening:
Carried out in community settings such as health fairs, workplaces, or schools.
Benefits: Improves access, especially in underserved areas

Self-Screening Tools:
Home-based kits and digital tools for monitoring and early detection.
Examples: Blood pressure cuffs, at-home colon cancer tests.

Question 14

What are 2 details about chronic disease prevention and health promotion?

Answer 14

The third level of chronic disease prevention activities targets primary prevention of chronic diseases and the
promotion of wellness, which can deter the development of chronic diseases from the outset

Individual- and population-level improvements in chronic disease prevention require primary prevention actions targeting the multiple determinants of health, including medical care, health behaviors, and the social and physical environment