The discussion of the soaring costs of health care in the U.S. often focuses on the high costs of treating diseases, rather than on the potential economic benefits of preventing them. Changes in lifestyle and diet could prevent many of the chronic diseases driving up the nation’s health care costs, improve health, and reduce the need for expensive treatments.
As we write in a new Milken Institute report, U.S. health care costs for chronic diseases such as heart disease, cancer, diabetes, and Alzheimer’s disease totaled $1.1 trillion in 2016. When lost economic productivity is included, the total economic impact was $3.7 trillion. This is equivalent to nearly 20 percent of the U.S. gross domestic product.
In terms of risk factors, being overweight or obese accounted for $1.7 trillion, or 47 percent of the total cost. Approximately 8.7 percent of health-care spending in the U.S. is attributable to cigarette smoking; 60 percent of that is paid by public sources — Medicare, Medicaid, and other U.S. federal and state health programs. Health problems caused by excessive drinking cost $27.4 billion in 2010, or 1 percent of the total cost of chronic diseases and 11 percent of the total costs of alcohol abuse.
The fastest way to lower costs, or at least to slow the upward spiral, is to reduce the number of Americans who carry excess weight, smoke, or drink too much alcohol. The share of American adults classified as obese increased from 13 percent in 1960 to almost 40 percent in 2016. Another 33 percent are overweight. Epidemiologic research has established a strong link between obesity and chronic diseases such as heart disease, kidney disease, and several types of cancers.
Unless Americans make changes in their lifestyles and the food industry changes the way food is prepared and marketed, the number of people with chronic diseases — and the cost of treating them — will continue to rise. The aging of the U.S. population compounds these challenges, as both the prevalence and severity of chronic diseases increase with age. The Partnership to Fight Chronic Disease estimates that by 2030, 83 million people in the U.S. will have three or more chronic health conditions, up from 31 million in 2015.
That trend highlights America’s health care dilemma. We spend over $10,000 per person every year on health care, more than any other country, yet our life expectancy is below the average of other high-income countries. Behavioral factors — unhealthful eating, a lack of exercise, smoking, and excessive use of alcohol — are among the reasons.
We need to address these cost drivers.
The Chronic Disease Management Act now before Congress is a step in the right direction. The legislation would enable more patients to receive preventive services by permitting high-deductible insurance plans to cover prevention before the deductible is met.
Other promising approaches include public awareness and health education campaigns, as well as financial incentives for weight loss, exercise, and smoking cessation. Infrastructure improvements can encourage more people to walk, jog, and bike. Whether through regulation or self-policing, food companies need to reduce the amount of salt, fat, sugar, and other unhealthy additives in their products. The use of taxes and regulation to limit consumption of unhealthy foods, tobacco, and alcohol also merits consideration.
Finland offers an example of how to do this. In the early 1970s, the province of North Karelia had the highest heart attack rate in the world. What came to be known as the North Karelia project led to a 63 percent decline in deaths from coronary heart disease for men between the ages of 30 and 64. The proportion of men who smoked regularly declined from 52 percent to 36 percent.
The project, which continued for more than two decades, went beyond educating consumers about healthier diets, getting more exercise, and the hazards of smoking. It persuaded farmers to produce less red meat and dairy products in favor of the vegetables and berries that grow well in Finland’s cold climate, and lobbied food processors to reduce potentially harmful ingredients in packaged food.
A project like this for the U.S. could include similar measures, including a reexamination of agricultural subsidies that indirectly lower the cost of many processed food products and sugar-sweetened beverages.
Prevention is far cheaper than treatment — but changing health-related behaviors is difficult. The federal government has been fighting obesity since at least 1956 when President Dwight Eisenhower created the President’s Council on Youth Fitness. Yet obesity rates have soared.
We’ve had better success with smoking. Beginning with the landmark 1964 surgeon general’s report on smoking and health, concerted public health, regulatory, and economic efforts have lowered the smoking rate from nearly 45 percent in 1965 to about 15 percent today.
There are hopeful signs on the horizon in the fight against chronic diseases: increased awareness of their growing economic burden along with pressure from employers and public and private insurers has reinvigorated the call to focus on prevention. Combatting chronic diseases before they occur may prove to be an effective way forward.
Advances in medical technology and science are enabling medical treatments scarcely imagined only a few years ago. “Targeted” therapies attack cancer at the molecular and cellular level and can be customized to fit a person’s genetic makeup; bionic limbs give amputees more active lives.
We need similar “targeted” therapies aimed at human behaviors. Finland’s success reducing heart attacks in North Karelia and the effectiveness of anti-smoking campaigns in the U.S. show that the right combination of education, policy, and incentives can work. It is time apply these lessons widely to fight the drivers of our chronic disease epidemic.
Hugh Waters, Ph.D., is director of health economics research at the Milken Institute. Marlon Graf, Ph.D., is a health research analyst at the institute.