Coordinated Chronic Disease Program Launched

Chronic diseases—such as arthritis, heart disease, cancer, and diabetes^1,2,3—are the leading causes of death and disability in the United States, accounting for 70% of all deaths and about 75% of the $2.6 trillion⁴ the nation spends on health care services.
To the nation's credit, some progress has been made in tackling chronic diseases—death rates from heart disease and stroke, for example, have declined dramatically, and lung, breast, and colorectal cancer rates have dropped significantly.
But the battle to overcome these mostly preventable diseases, which afflict more than 130 million Americans,² is being reinvigorated by a new approach.
As part of CDC's continuing effort to accelerate the nation's ability to prevent and control chronic diseases, the agency recently launched an initiative designed to help states deliver the interventions that can help manage chronic diseases and address the multiple "risk factors" or root causes that underlie them—smoking, poor eating habits, lack of physical activity—in a more coordinated and focused way.
"'The way we have always done it' was not a planned, systematic approach, but a patchwork approach that evolved in response to threats and opportunities over the past few decades. It is no longer a model that will deliver the health outcomes our citizens are demanding in these changing times," Dr. Ursula Bauer, director of CDC's National Center for Chronic Disease Prevention and Health Promotion, told more than 200 state health department leaders who attended a regional meeting in Atlanta earlier this month to kick off the new program. "The Coordinated Chronic Disease Program invites all of us to rethink how we do things and broaden our impact. It's a chance to do a few things well."

The Program

The Coordinated Chronic Disease Prevention and Health Promotion Program (CCDP) was launched in September with the awarding of $39 million to 58 grantees—all 50 states, the District of Columbia, and seven territories—to build and strengthen the capacity of state health departments to prevent chronic disease and promote health at a time when state, local, and federal budgets are coming under severe constraints, resulting in layoffs of many of the nation's public health professionals.
The purpose of the program is to—

Ensure that every state has a strong foundation for chronic disease prevention and health promotion.
Provide leadership and expertise to work collaboratively across chronic disease conditions and risk factors to most effectively meet population health needs, especially for populations at greatest risk or with the greatest burden.
Maximize the reach of categorical chronic disease programs in states (i.e., heart disease and stroke, diabetes, obesity, cancer, arthritis, tobacco, nutrition, and physical activity) by sharing basic services and functions such as data management, communication, and partnership development.
Improve the way CDC provides assistance to state health departments.

State activities

State health departments began taking a coordinated approach to chronic diseases several years ago to demonstrate the potential benefits of an integrated model in some of the following ways:

Colorado, which began moving toward an integrated approach in 2006, has developed a statewide Public Health Improvement Plan that prioritized the state's winnable battles and identifies where additional resources are needed. The plan calls for doing things differently.
New York's diabetes, obesity, and nutrition programs pooled funds to award 5-year grants to 22 community organizations to support policy and environmental strategies aimed at increasing physical activity and improving access to healthy foods.
Wisconsin collaborated with the state's Aging Network and the state's Medicaid program to expand access to evidence- based community programs such as the Chronic Disease Self-management Program (CDSMP). CDSMP is a low-cost, community-based, 6-week series of classes for people with chronic diseases that was developed at Stanford University. The program specifically addresses arthritis, diabetes, lung and heart disease, but also teaches skills useful for managing a variety of chronic diseases.
North Carolina's Chronic Disease and Injury Section (CDIS) has developed Communities of Practice (CoPs) in key areas; such as, healthy communities, policy, and health data. Staff that participate in these COPs, which meet monthly and are overseen by co-chairs and a management-level "champion," work across programs to address issues affecting each participating community . Groups might provide technical assistance to communities about the various programs; coordinate a policy related effort; or work to collect and share cross-cutting data. Each CoP develops, implements, and evaluates an annual action plan and tracks their accomplishments through success stories.

With these four states demonstrating that there are different ways to coordinate activities with the goal of maximizing impact on chronic diseases, the CDC's coordinated program does expect every state to deliver tangible results within the first year of the program. Each state should—

Develop or update a State Chronic Disease Prevention Plan that includes a statewide chronic disease prevention and health promotion coalition of partners.
Develop and implement a management plan for leadership in chronic disease prevention. These plans should ensure that each state has functions, people, capacity, and skills available to state categorical chronic disease programs in key areas including surveillance and epidemiology, communication, and effective partnerships.

"Our goal and our hope is that this program will play a critical role in creating the state health department of the future," said Wayne Giles, Director of the CDC's Division of Population Health, "where we are accelerating our efforts to prevent and control chronic diseases by focusing on the best and most effective way to maximize our statewide impact on the risk factors that lead to them."

Reference:

Kung HC, Hoyert DL, Xu JQ, Murphy SL. Deaths: final data for 2005. National Vital Statistics Reports 2008;56(10). [PDF-2.3MB]
Wu SY, Green A. Projection of Chronic Illness Prevalence and Cost Inflation. Santa Monica, CA: RAND Health; 2000.
Brault MW, Hootman J, Helmick CG, Theis KA, Armour BS. Prevalence and most common causes of disability among adults—United States, 2005. MMWR missing year;58(16): 421–426.
Martin A, Lassman D, Whittle L, Catlin A. Recession contributes to slowest annual rate of increase inhealth spending in five decades. Health Aff (Millwood). 2011;30(1):11–22.