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health behavior is very important, but we can't lose sight of the reality that it occurs in the context of where we live and work. Why do certain populations have a ...

BAOJ Diabetes Inuka G Midha, BAOJ Diabet 2015 1: 1 1: 005

Editorial article

The Surging Enigma of Chronic Diseases: Challenges and Possibilities Inuka Midha* Regents of the University System of Georgia, USA

The five leading causes of death are heart disease, cancer, COPD, stroke, and accidents. Four of these five worst killers are caused by chronic diseases [1]. Nearly half of the U.S. population has either asthma, heart disease, or diabetes. Those three diseases alone make up 85 percent of national healthcare spending. Even more adults (60 percent) are either overweight or clinically obese, conditions that are highly correlated with chronic illnesses [2]. Over the last 15 years, the number of cases of diabetes, primarily type 2 (formerly called non-insulin dependent) diabetes has doubled, and a quarter of those people don’t know they have the disease. Today, 24 million Americans have diabetes, and another 54 million have prediabetes, meaning they are at increased risk for developing diabetes [3]. Certain populations such as the elderly, minority groups, and groups with lower socioeconomic status are disproportionately burdened by the disease. If current trends continue, 1 in 3 Americans (including children) will develop diabetes during their lifetime. Unless it is managed well, diabetes is progressive. The medical complications can play havoc on every major organ in the body, leading to complications such as stroke and heart disease, amputations, end-stage kidney disease, and blindness. Globally diabetes is the fourth leading cause of death by disease [3]. Up to half of type 2 diabetes cases in the United States can be prevented by adopting a healthy diet and increasing physical activity. It’s no secret that the heart of combating the progression of any chronic disease including type 2 diabetes, obesity and heart disease, etc. is to move beyond clinical care alone and involve the entire community. “It’s not just what goes on in the doctor’s office, but also how we educate people and how we support healthy lifestyle choices, such as providing or supporting facilities for people to exercise in a safe environment. It’s working with leaders to accept that this is a public health challenge and not just a clinical problem,” says Frank Vinicor, MD, MPH, former director of the Division of Diabetes Translation at Centers for Disease Control and Prevention [4]. Too often in public health, education practitioners tend to focus first and foremost on how to change individual behavior. Clearly, health behavior is very important, but we can’t lose sight of the reality that it occurs in the context of where we live and work. Why do certain populations have a disproportionately high rate of lung cancer, heart disease, diabetes or other chronic conditions? Reasons for the increased prevalence of chronic conditions are multifactorial, including an aging population plus a rise in diseasespecific risk factors such as obesity. Most of the analyses suggest BAOJ Diabet, an open access journal

that the determinant of those issues is more heavily socioeconomic (e.g. lower socio-economic position, sedentary behavior, heavy alcohol intake, poor diet, etc.) [3,5]. There are two big issues that public health has not sufficiently addressed, one of which is health disparity [6]. defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage” [7]. The largest sources of the gap in life expectancy between rich and poor, between minority and majority, are in fact the chronic diseases. And when we look closer, the differences are around cardiovascular disease, cancer, and diabetes [3]. The centrality of health disparity for our nation as a whole has got to get higher attention. When low-income portions of society, because they have no insurance, have to turn to the emergency medical system for care we realize that we have a system that doesn’t give all people access to care. One of the major challenges is how do we get equity in health care? The most urgent need is to develop specific solutions, identify the interventions that are most effective, and implement them in the real world. One example of a step in the right direction is REACH U.S. program (Racial and Ethnic Approaches to Community Health across the United States), which funds 40 U.S. communities to advance the prevention and elimination of health disparities. REACH U.S. provides communities with critical resources and training needed to develop and disseminate culturally appropriate strategies that promote health equity [7]. Promoting healthier outcomes requires looking at behavior as well as engaging the community at large. A growing body of evidence indicates that well-planned, community-based programs do result in documented improvements in knowledge, behaviors, policies, and health status. Culturally tailored approaches to care may also improve care for ethnic minorities by providing a mechanism for individualizing care.  *Corresponding author: Inuka G Midha, 2680 Lawrenceville Hwy, Decatur, Ga 30033, Regents of the University System of Georgia,USA; Tel: 404-2004676; Email: [email protected] Sub Date: December 24, 2015, Acc Date: December 29, 2015, Pub Date: December 30, 2015. Citation: Inuka Midha (2015) The Surging Enigma of Chronic Diseases: Challenges and Possibilities. BAOJ Diabet 1: 005. Copyright: © 2015 Inuka G Midha. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Volume 1; Issue 1; 005

Citation: Inuka Midha (2015) The Surging Enigma of Chronic Diseases: Challenges and Possibilities. BAOJ Diabet 1: 005.

Thus, positive signs of progress in the direction of chronic disease management and prevention are apparent, and despite an outlook that may have once been seen as particularly dire, many novel promising and pragmatic initiatives are emerging. For example, the International Union against Tuberculosis and Lung Disease and WHO have recently joined forces in providing a collaborative framework for the care and control of diabetes and TB [8]. This is indicative of the recognition of the significant challenge of finding solutions to control the rising surge of chronic diseases, and represents a unique opportunity to capture individuals within culturally specific communities confronting the multiple burdens of chronic disease conditions as potential targets for screening and treatment. Such examples of strategic, community-based initiatives that identify emerging needs, address gaps in capacity, improve service delivery, and prioritize follow-up evaluation are vital [5]. The other issue at the forefront of major public health challenges of our times is that of quality of life and life satisfaction. It’s the next big thing with an aging population. People don’t just want to live long, they want to live well. The population over age eightyfive, the group with the highest proportion of people with multiple chronic conditions, is projected to grow from five million in 2005 to twenty-one million in 2050, ensuring a major increase in the number of very-high-cost patients [9]. Identifying key factors that drive aging, clarifying their activities in different systems, and in particular understanding how they interact will enhance our comprehension of the aging process, and could yield insights into the permissive role that senescence plays in the emergence of acute and chronic diseases of the elderly. On the whole, people are healthier than they were before, and this is mostly due to public health programs. There’s no reason to think that such progress will stop. The challenge for us is how to keep it going and how to do it in new, creative, and cost-effective ways. If there is a really good reason to do something, and if you can make a case for it, sooner or later if you persevere, it’s going to happen. A lot of talented people in many different fields don’t think about public health as an option for their work. But we need

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economists, anthropologists, political scientists, geneticists, and many others. It’s not just individuals trained through public health routes who can bring their talent to bear on public health issues. One of the most exciting environment is the cross discipline work and the benefit of tackling public health problems from different perspectives. We need to market the excitement of public health and bring diverse expertise to bear on these problems.

References 1. CDC gov 2013 Deaths and Mortality. 2. CDC.gov, 2013 Chronic Disease Overview. Centers for Disease Control & Prevention. 3. Kreuter M 2009 Understanding Health Behavior in the context of Community, Chronic Disease Notes and Reports. Centers for Disease Control and Prevention 19(1) Supplement: 1-15. 4. Vinicor F 2001 Department of Health & Human Services (HHS.gov), Diabetes in American Indians: The Public Health Problem and the Response – Challenges and Opportunities. 5. Lyons JG, Stewart S 2013 Tuberculosis, diabetes and smoking: a burden greater than the sum of its parts. International Journal of Epidemiology 42 (1): 230-232. 6. Healthy People 2020 disparities. Foundation health measures. 7. Centers for Disease Control & Prevention, 2014. Strategies for Reducing Health Disparities-Selected CDC Sponsored Interventions, United States, 2014, Morbidity & Mortality Weekly Report (MMWR) Supplement 63 (1) 1-52. 8. World Health Organization, Union Against TB Lung Disease 2011 Collaborative framework for care and control of tuberculosis and diabetes. World Health Organization and International Union against TB Lung Disease. 9. Bodenheimer T, Chen E, Benett HD 2009 Confronting the growing burden of Chronic Disease: Can the U.S. HealthCare Workforce Do The Job? Health Affairs, 28(1):64-74.

Volume 1; Issue 1; 005