Moving upstream: Assessing the causes, consequences and costs of chronic conditions

Americans are living longer, but also experiencing higher rates of chronic physical and psychological conditions. Coupled with declining rates of health insurance coverage, diminished access to care, rising rates of obesity, poor dietary habits, increased stress, and other social and environmental determinants of health, chronic conditions – and preventable disability – are likely to increase exponentially in coming years. Relationships between these factors are complex, and efforts to forecast trends among them are less important as literal "readings of the future" than as attempts to unpack their individual and collective influence on health status. Poor health status extracts large costs, including medical costs, costs related to loss of productivity, and diminished quality of life. Using data from a statewide survey of 4,200 adults in Arizona, we explore the prevalence, antecedents and consequences of chronic conditions, and suggest strategies that may help to stem the tide. Over half (58%) of Arizona adults have been diagnosed with one or more chronic conditions, and preliminary findings suggest that beyond the physical burden of disease, associated financial and social burdens are also considerable. Findings also suggest that medical care alone will be insufficient to address the increasing prevalence of chronic conditions. Public policy should shift focus to more effectively mitigate the negative effects of upstream social and environmental factors that underlie many chronic conditions. By encouraging health promotion, education and targeted disease prevention programs, public health policy may prove an effective tool for addressing broader issues of rising medical costs and declining economic productivity.