Chronic disease requires global, national, individual effort

Though the focus of public health efforts in less-developed nations often is on ravaging infectious diseases like malaria and AIDS, the burden of chronic diseases such as respiratory disease, cancer and heart disease has grown alarmingly.

(Photo courtesy Noreen Clark)

"Chronic diseases are the most costly, in human and financial terms, in almost every country of the world—and increasingly costly in those areas where infectious disease is rampant," says Noreen Clark, who has been named the Myron Wegman Distinguished University Professor of Public Health. "Further, chronic disease and infections often interact, making the burden greater. Moreover, AIDS has become a chronic disease."

Clark will give her distinguished university professor address, "Putting People at the Center of Solutions: Controlling Chronic Disease," at 3 p.m. Oct. 26 as part of the opening ceremonies for the new School of Public Health Crossroads building, 109 Observatory. The event will be held in the Lane Family Auditorium, Room 1690 in the SPH Crossroads, with a reception to follow.

"In most countries of the world, half the people have chronic disease," she says. "In the U.S. it is the same number: half. Two-thirds of older Americans and a quarter of American children also have chronic disease." Of the $7,000 per person that the United States now spends on health care, 70 percent of that cost is for chronic conditions.

Clark's major research thrust is aimed at doing something about the problem of chronic disease management before health care systems around the world reach the breaking point. What she and colleagues around the country are finding is that educating and empowering patients to take a lead role in managing their chronic conditions is more effective and affordable than the acute crisis model generally seen in health care systems.

"If we don't revamp our systems to put the people living with chronic disease in the center of management efforts, this country and others will be deluged by an aging population with multiple chronic problems and no systemic means to help them," Clark warns. "This situation would definitely break the health care bank."

Patients aren't reluctant to participate in their own health maintenance, but the American health care system hasn't set them up to do it. "Our health systems should be adapted to enable those with chronic illness to manage their conditions more independently and effectively," Clark says.

Key is changing the way we think about health care investments and reimbursement, she says. Education is effective and affordable, but isn't the sort of thing that gets reimbursed under the current system.

"My hope is to have some influence on how we think about the problem of chronic diseases," Clark says.

A member of the Council on Foreign Relations and Family Care International, Clark has spent considerable time and effort on developing and testing interventions designed to improve health status, quality of life and collaborative activity among people in the United States, as well as East Africa and Asia.

Clark has published more than 125 scientific articles related to public health and disease management and is a member of the Institute of Medicine of the National Academies of Science. She has a doctorate and master's degree from Columbia University, and did her undergraduate work at the University of Utah.