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Chronic diseases make for a perfect storm

October 1, 2008
by Ronald W. Manderscheid, PhD
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Mental health and substance use care providers have a role in combating them

The premature death of public mental health clients is caused principally by untreated chronic diseases. Hence, it is critical for us to develop a better understanding of the current status of chronic diseases in the United States.

The new Partnership to Fight Chronic Disease ( was formed because chronic diseases are perceived to be “the single greatest threat to our nation's health and to our health care system.” These chronic diseases include cancers, diabetes, heart disease, hypertension, stroke, mental disorders, and pulmonary conditions, such as asthma. In the United States, these chronic diseases account for more than 75 cents of every dollar spent on healthcare, are the number-one cause of death and disability, and are the number-one driver of rising healthcare costs, according to the Centers for Disease Control and Prevention (

A recent Milken Institute ( study on chronic diseases, An Unhealthy America: The Economic Burden of Chronic Disease, had several important findings. First, more than 109 million Americans have at least one of seven chronic diseases, for a total of 162 million cases as follows:

  • Cancers, 10.6 million cases (3.6% of the population)

  • Diabetes, 13.7 million cases (4.7%)

  • Heart disease, 19.1 million cases (6.6%)

  • Hypertension, 36.8 million cases (12.6%)

  • Mental disorders, 30.3 million cases (10.4%)

  • Pulmonary conditions, 49.2 million cases (16.9%)

  • Stroke, 2.4 million cases (0.8%)

On our current path, the Institute predicts a 42% increase in cases of the seven chronic diseases by 2023 and $4.2 trillion in treatment costs and lost economic output.

Under a more optimistic scenario, assuming modest improvements in preventing and treating disease, the Institute found that we could avoid 40 million cases of chronic disease by 2023, and we could reduce the economic impact of disease by 27% or $1.1 trillion annually. We also could increase the nation's gross domestic product by $905 billion linked to productivity gains, and we could decrease treatment costs by $218 billion per year. Lower obesity rates alone could produce productivity gains of $254 billion and avoid $60 billion in treatment expenditures per year.

To complete this picture, several important related factors need to be considered:

  • The Census Bureau projects that the elderly population age 65 and older will grow by 35 million persons by 2030. This age group is at a very high risk of chronic diseases.

  • During the next 15 years, most of the baby-boomer healthcare providers will retire. Key disciplines that treat chronic diseases, such as primary care, family practice, psychiatry, and nursing, already report recruitment difficulties. As a result, we can expect that shortages will occur in our capacity to treat chronic diseases.

  • Unless redesigned, Medicare will begin to experience significant resource shortfalls in 2013 and succeeding years. Similar problems can be expected in Medicaid, the major public healthcare payer for those who live in poverty.

  • 17% of the U.S. population is without any health insurance. Because of a lack of preventive care, it is likely that this population will contribute disproportionately to the subgroups with chronic diseases.

Thus, chronic diseases represent an extremely large and growing problem in the United States. The toll in terms of death, suffering, and cost is staggering. Furthermore, our human and financial resources to address chronic diseases are threatened. The problem of chronic diseases has the makings of a perfect storm.

What can we in the mental health and substance use care fields do about this problem? Two principal courses of action seem open to us:

Screen and treat. We must screen for chronic diseases in all mental health and substance use care recipients and provide appropriate treatment. Furthermore, if we can treat early, then we can mitigate more severe health problems likely to develop later.

Prevent and forestall. We must develop and broadly implement new evidence-based procedures focused on wellness. Some of these should be designed for providers; in the future, no provider should prescribe a psychotropic medication without also prescribing a wellness regimen. Alternately, some of these procedures should be designed for direct use by persons who receive services. Clearly, self-help and peer support are key elements of wellness. Both must be mobilized.

A major part of surviving a perfect storm is to care for oneself and to help each other. Both will be necessary to fight chronic diseases successfully.

Ronald W. Manderscheid, PhD, is Director of Mental Health and Substance Use Programs at the consulting firm SRA International. Dr. Manderscheid worked for more than 30 years in the federal government on behavioral health research and policy. He is a member of

Behavioral Healthcare's Editorial Board.

To contact Dr. Manderscheid, e-mail