Living Well With Chronic Disease
Living Well with Chronic Illness: A Call for Public Health Action is a recent report from the Institute of Medicine, requested by the Centers for Disease Control and Prevention and the Arthritis Foundation to help identify public health actions to reduce disability and improve the function and quality of life for people living with chronic illness.
Among the major findings of the report:
- All chronic illnesses hold the potential to worsen the overall health of our nation by limiting an individual’s capacity to live well.
- Evidence-based interventions aimed at preventing chronic disease (such as stopping smoking, eating better and limiting weight gain) need to be studied in people with one or more chronic illnesses to assess their effectiveness in preventing further illness.
- Enhanced collaboration among the public health, health care, and community sectors could produce better prevention and treatment outcomes for people living with chronic disease.
NewPublicHealth spoke with Robert Wallace, MD, chair of the IOM committee that developed the report. Dr. Wallace is the director of the Center on Aging at the University of Iowa College of Public Health.
NewPublicHealth: What do you think would strengthen public health actions to manage chronic disease?
Dr. Wallace: A complex question. First of all, everyone appreciates that improving the quality of life for people with chronic illness and mitigating progression is a job jointly for the health care system and the public health system. There really needs to be a lot of research. This wasn’t supposed to be a research treatise, and it’s not in the end, but what comes up all the time is–do public health interventions to prevent diseases also reach and have an impact on persons who already have a chronic illness? And that’s not quite so well known.
People with chronic illness need prevention for not only the illnesses they have and follow-on illnesses, but they need primary prevention for everything else because they’re still citizens trying to make their way in the world. And so one of the questions is: irrespective of what disease they have, we should try to get people to stop smoking or to take the fat out of their diet or get some more exercise or whatever it happens to be. So, one of the main points here then is that we need to know more about how public health interventions reach people with chronic illness and does it help them?
NPH: What benefits could be had from enhanced collaboration among public health, health care and community non-health sectors?
Dr. Wallace: There are many, many different models of chronic disease care. Many of them, of course, start with the health care system and giving good therapeutics and good preventives and good advice and education. We deal with this in some depth in the report. These could be direct preventive interventions, and many of the health department’s chronic disease control programs actually do that. They gather up and do education for diabetics, usually type 2 diabetes, and so there are approaches to this as well, but what we’re arguing for in the end is an alignment between the health care system and the public health system that actually gets them to work together and we call for CDC and other parts of the federal government to serve a catalytic and a convening function to try to help get this done. Now, also important for all of this is, of course, is the patient and self-management, and so a lot of this comes down to helping people help themselves.
NPH: How do you think this report helps the prevention effort?
Dr. Wallace: One of the important implications of primary prevention is that it needs to be packaged and reconciled with preventive activities and public health activities that touch individuals with chronic illness because there are a lot of things to do and they have to be organized. I think the primary message for us is that you have to attend to people with chronic illness to be inclusive. We want to include as many different kinds of illnesses as is possible, but, of course, like everyone else we want an evidence base that shows that public health interventions actually have an impact.
NPH: What are next steps?
Dr. Wallace: One of the key frontiers is trying to get employers who deal with low-wage workers and employers in small businesses to try to use those business locations as one venue for delivering preventive interventions, where appropriate, for persons who are working and have chronic illnesses. We were very mindful of the need to deliver proven community interventions wherever it’s feasible and can reach a large number of people.