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Resources and Priorities for Chronic Disease Prevention and Control, 1994

Chronic diseases (e.g., heart disease, cancer, stroke, diabetes, chronic obstructive pulmonary disease, and chronic liver disease) are the major causes of death, disability, and medical expenditures in the United States (1). Although these six diseases accounted for 73% of all U.S. deaths in 1993 (2), characterization of the capacity and priorities of public health agencies to prevent or control these chronic diseases has been limited. To assess the resources, needs, and priorities in chronic disease prevention and control for fiscal year (FY) 1994, the Association of State and Territorial Chronic Disease Program Directors (ASTCDPD) conducted a national survey of state and territorial health agencies; this survey updates a similar survey that collected data for FY 1989 (3,4). This report summarizes the survey findings for 1994, which indicate that, during 1989-1994, expenditures for state-specific chronic disease activities increased modestly but remained disproportionately low in relation to the public health burden of chronic diseases.

In April 1995, ASTCDPD mailed a questionnaire to the ASTCDPD voting member in each state and U.S. territory. The survey addressed four categories: 1) resources; 2) plans and priorities; 3) links with other organizations; and 4) laws, policies, and standards. Responses were received from 41 states and Guam. * Per capita expenditures for the 41 states were calculated using estimates based on the 1990 census.

For FY 1994, the total reported expenditure for chronic disease-control activities in the 41 reporting states was $287,306,934, and the per capita expenditure was $1.21 (range: $0.13-$3.20). In comparison, for FY 1989, the reported total expenditure for all 50 states, the District of Columbia, Guam, and the Virgin Islands was $245,371,377, and the per capita expenditure was 99[ (range: 0-$3.83) (4); for the same 41 states that responded for 1994, expenditures were $236,145,920 and $1.05 (range: $0.17-$3.83), respectively. For FY 1989, the primary source of chronic disease-control resources was state funds (77%), followed by federal sources (20%) (3); in comparison, for FY 1994, state funds accounted for 39% of resources and federal funds for 45%. The most frequently reported priorities by disease, risk factor, and population subgroup were cancer, tobacco use, and youth, respectively.

Reported by: R Brownson, PhD, School of Public Health, Saint Louis Univ, Missouri. E Dixon Terry, MPH, F Wheeler, PhD, A Yerkes, MPH, D Bourne, MD, F Bright, MS, J Chabut, P Huang, MD, P Marmet, MS, S Michael, MS, J Mitten, MHE, D Momrow, MPH, R Moon, MPH, R Schwartz, MSPH, E Sternberg, MPH, B Wadsworth, MA, K Ward, Association of State and Territorial Chronic Disease Program Directors. Div of Adult and Community Health (proposed), National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: In 1990, chronic diseases, which are in large part preventable, accounted for an estimated $425 billion (61%) of total U.S. medical-care expenditures (5); however, in 1994, the per capita public health expenditure for chronic disease prevention and control was only $1.21. Although comparable figures for 1994 are not available, in 1989, chronic disease-control expenditures accounted for only 3% of state health department expenditures (4).

Risk factors for premature death and preventable morbidity from chronic diseases are tobacco use, high blood pressure, high blood cholesterol, overweight, physical inactivity, poor nutrition, heavy alcohol consumption, and failure to use screening tests (e.g., mammography and the Papanicolaou smear) (1,6,7). Important strategies for controlling these risk factors include promoting public health policies that foster disease prevention, collaborating with community organizations in health-promotion efforts, ensuring the delivery of appropriate preventive services in health-care settings, and providing health education in schools (8). The findings of this analysis are being used to increase awareness among state leaders about the disparity between the magnitude of the public health burden of chronic diseases and the resources available for chronic disease-prevention and -control programs in state health departments.


  1. Taylor WR, Marks JS, Livengood JR, Koplan JP. Current issues and challenges in chronic disease control. In: Brownson RC, Remington PL, Davis JR, eds. Chronic disease epidemiology and control. Washington, DC: American Public Health Association, 1993:1-18.

  2. Gardner P, Hudson BL. Advance report of final mortality statistics, 1993. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, National Center for Health Statistics, 1996. (Monthly vital statistics report; vol 44, no. 7, suppl).

  3. Association of State and Territorial Chronic Disease Program Directors. Reducing the burden of chronic disease: needs of the states -- executive summary. Washington, DC: Public Health Foundation, 1991.

  4. CDC. Chronic disease prevention and control activities -- United States, 1989. MMWR 1991;40:697-700.

  5. The Robert Wood Johnson Foundation. Annual report, 1994: cost containment. Princeton, New Jersey: The Robert Wood Johnson Foundation, 1995.

  6. Hahn RA, Teutsch SM, Rothenberg RB, Marks JS. Excess deaths from nine chronic diseases in the United States, 1986. JAMA 1990;264:2654-9.

  7. McGinnis JM, Foege WH. Actual causes of death in the United States {Comments}. JAMA 1993;270:2207-12.

  8. CDC. Unrealized prevention opportunities: reducing the health and economic burden of chronic diseases. Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, CDC, 1997.

* Data were not provided from Arizona, Delaware, the District of Columbia, Hawaii, Kansas, Massachusetts, New Hampshire, New Mexico, Oregon, West Virginia, and the Virgin Islands.

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