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.
References
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.
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).
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.
CDC. Chronic disease prevention and control activities -- United
States, 1989. MMWR 1991;40:697-700.
The Robert Wood Johnson Foundation. Annual report, 1994: cost
containment. Princeton, New Jersey: The Robert Wood Johnson
Foundation, 1995.
Hahn RA, Teutsch SM, Rothenberg RB, Marks JS. Excess deaths from
nine chronic diseases in the United States, 1986. JAMA
1990;264:2654-9.
McGinnis JM, Foege WH. Actual causes of death in the United
States {Comments}. JAMA 1993;270:2207-12.
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.
Disclaimer
All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.
**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.
