Chronic costs: making healthy choices easier for Americans can prevent deadly diseases and save money.

• Author: Winterfeld, Amy

Cut health care costs--but don't do it by killing off grandma.

Those are the marching orders for health reform. But what are the real options for reducing health care expenditures?

One is to reduce the cost of chronic diseases that increasingly afflict our population. Chronic conditions account for more than 75 percent of U.S. health care spending, according to research by Johns Hopkins. Seven of the most common chronic diseases--diabetes, heart disease, cancer, stroke, high blood pressure, pulmonary conditions and mental disorders--cost the American economy an estimated $1.3 trillion annually, $280 billion for treatment and $1 trillion in lost productivity, says the Milken Institute, a nonpartisan think tank.

If we do nothing to prevent these diseases, researchers estimate the annual cost could balloon to $4.2 trillion by 2023. Exactly how much can be saved, and over what time period, is subject to debate. What's not in dispute, however, is that many promising state policies and programs could help prevent some of the most prevalent chronic diseases and reduce their costly complications.

"Chronic diseases linked to obesity, poor nutrition, physical inactivity and tobacco use are the leading causes of death and disability in our nation," says Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.

Smoking, not exercising and eating poorly are the top three behaviors that actually cause preventable illnesses and death in the United States. These behaviors contribute to deaths from this nation's three leading killers--heart disease, cancer and stroke--and the sixth leading cause of death, diabetes. In addition, 36 million Americans--12 percent of the population--live with disabilities caused by chronic conditions that limit their daily activities.

Although "chronic diseases are costly and common," says David Hoffman, director of Chronic Disease Prevention and Control for New York state, they "are also often preventable. Prevention is an investment and there is growing evidence that it works. The combination of clinical and community prevention can have a real impact on both improved quality of life and health care costs."

Programs that increase physical activity, improve nutrition and prevent smoking and other tobacco use have a return on investment of $5.60 for every $1 invested, according to the Trust for America's Health, a public health advocacy group. An investment of $10 per person over five years could save Medicare, Medicaid and private insurers $16 billion annually, including $5 billion in Medicare and $1.9 billion in Medicaid costs.

TACKLING TOBACCO

Tobacco use costs taxpayers more than $96 billion in medical expenses and $97 billion in lost productivity every year, according to the Centers for Disease Control. Nearly half of the 44.5 million Americans who smoke will die...