and overall health for some persons with chronic illness through advances in corrective surgery, new approaches in analgesia, better rehabilitation and physical and occupational therapy, improved nutrition management, and adaptation of home and community environments for functionally impaired persons.

However, these advances have been compromised by parallel increases in physical inactivity, unhealthful eating, obesity, tobacco use, and other chronic disease risk factors. Today, more than one in four Americans has multiple (two or more) chronic conditions (MCCs), and the prevalence and burden of chronic illness among the elderly and racial and ethnic minorities are notably disproportionate. Chronic disease has now emerged as a major public health problem, and it threatens not only population health but also social and economic welfare.

Cardiovascular disease, many cancers, stroke, and chronic lung disease are the most common causes of death in America. But there are also other chronic diseases, such as arthritis, asthma, depression, and epilepsy, which have less substantial contributions to mortality but can severely diminish the health-related quality of life of the individuals who live with them, and effective disease prevention programs are not well developed.

Chronic illnesses not only impact the social and economic lives of millions of Americans and their families but also are a major contributor to health care costs. The medical care costs of people with chronic illnesses represent 75 percent of the $2 trillion the United States spends annually on health care (Kaiser Family Foundation, 2010). By 2030, the global economic burden of noncommunicable chronic diseases is estimated to be $47 trillion (Bloom et al., 2011).

In 2010, CDC and the Arthritis Foundation sought assistance from the Institute of Medicine (IOM) to identify the population-based public health actions that can help reduce disability and improve functioning and quality of life among individuals who are at high risk of developing a chronic illness and those with one or more chronic illnesses.

The Statement of Task (Box S-1) suggested the following diseases for the committee to consider: heart disease and stroke, diabetes, arthritis, depression, respiratory problems (asthma, chronic obstructive pulmonary disease [COPD]), chronic neurological conditions, and cancer. These diseases or categories of disease were not intended as a prescriptive set of diseases to include in the report. In fact, the committee was advised by the sponsors of this study not to focus on the common high-mortality diseases, but rather consider diseases that have the potential to cause or that actually cause functional limitations and/or disabilities. This guidance thus allowed the committee to consider all chronic diseases in the context of living well. With respect to primary prevention, the committee was advised to consider prevention only among individuals with high-risk factors (e.g., prediabetes).



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