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Living Well with Chronic Illness: A Call for Public Health Action
Committee on Living Well with Chronic Disease: Public Health Action to
ISBN
978-0-309-22127-6 Reduce Disability and Improve Functioning and Quality of Life; Institute of
Medicine
330 pages
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Copyright © National Academy of Sciences. All rights reserved.
Living Well with Chronic Illness: A Call for Public Health Action
Living Well with Chronic Illness: A Call for
Public Health Action
Committee on Living Well with Chronic Disease: Public Health Action to Reduce
Disability and Improve Functioning and Quality of Life
Board on Population Health and Public Health Practice
PREPUBLICATION COPY – UNCORRECTED PROOFS
Copyright © National Academy of Sciences. All rights reserved.
Living Well with Chronic Illness: A Call for Public Health Action
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National
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This study was supported by Contract No. DP000607 between the National Academy of Sciences and the Arthritis
Foundation, and Contract No. 200-2005-13434, TO# 30 between the National Academy of Sciences and the Centers
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Suggested citation: IOM (Institute of Medicine). 2012. Living well with chronic illness: A call for public health
action. Washington, DC: The National Academies Press.
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Copyright © National Academy of Sciences. All rights reserved.
Living Well with Chronic Illness: A Call for Public Health Action
PREPUBLICATION COPY – UNCORRECTED PROOFS
Copyright © National Academy of Sciences. All rights reserved.
Living Well with Chronic Illness: A Call for Public Health Action
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars
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Vest is president of the National Academy of Engineering.
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research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.
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Copyright © National Academy of Sciences. All rights reserved.
Living Well with Chronic Illness: A Call for Public Health Action
COMMITTEE ON LIVING WELL WITH CHRONIC DISEASE: PUBLIC
HEALTH ACTION TO REDUCE DISABILITY AND IMPROVE
FUNCTIONING AND QUALITY OF LIFE
ROBERT B. WALLACE (Chair), University of Iowa, Iowa City
RONALD T. ACKERMANN, Northwestern University Feinberg School of Medicine, Chicago,
IL
KAREN BASEN-ENGQUIST, The University of Texas, MD Anderson Cancer Center,
Houston
BOBBIE A. BERKOWITZ, Columbia University School of Nursing, New York, NY
LEIGH F. CALLAHAN, The University of North Carolina at Chapel Hill
RONNI CHERNOFF, Geriatric Research Education and Clinical Center, Central Arkansas
Veterans Healthcare System and Arkansas Geriatric Education Center, University of
Arkansas for Medical Sciences, Little Rock
DAVID B. COULTAS, The University of Texas Health Science Center at Tyler
SHERITA HILL GOLDEN, Johns Hopkins University School of Medicine, Baltimore, MD
JEFFREY R. HARRIS, University of Washington School of Public Health, Seattle
RUSSELL HARRIS, University of North Carolina at Chapel Hill
KATIE B. HORTON, The George Washington University School of Public Health and Health
Services, Washington, DC
M. JEANNE MIRANDA, Center for Health Services Research, University of California, Los
Angeles
MARCIA NIELSEN, Patient Centered Primary Care Collaborative, Washington, DC
OLUGBENGA G. OGEDEGBE, New York University Lagone Medical Center, New York
City
PATRICK REMINGTON, University of Wisconsin School of Medicine and Public Health,
Madison
DAVID B. REUBEN, David Geffen School of Medicine University of California, Los Angeles
MICHAEL SCHOENBAUM, National Institute of Mental Health, Bethesda, MD
Study Staff
E. LORRAINE BELL, Senior Study Director
PAMELA LIGHTER, Research Assistant
CHELSEA FRAKES, Senior Program Assistant
ANDREW LEMERISE, Research Associate
HOPE HARE, Administrative Assistant
AMY PRYZBOCKI, Financial Associate
ROSE MARIE MARTINEZ, Senior Director, Board on Population Health and Public Health
Practice
PREPUBLICATION COPY – UNCORRECTED PROOFS
v
Copyright © National Academy of Sciences. All rights reserved.
Living Well with Chronic Illness: A Call for Public Health Action
Copyright © National Academy of Sciences. All rights reserved.
Living Well with Chronic Illness: A Call for Public Health Action
REVIEWERS
This report has been reviewed in draft form by persons chosen for their diverse
perspectives and technical expertise, in accordance with procedures approved by the National
Research Council’s Report Review Committee. The purpose of this independent review is to
provide candid and critical comments that will assist the institution in making its published
report as sound as possible and to ensure that the report meets institutional standards for
objectivity, evidence, and responsiveness to the study charge. The review comments and draft
manuscript remain confidential to protect the integrity of the deliberative process. We wish to
thank the following individual’s for their review of this report.
Susan Babey, University of California, Los Angeles, Center for Health Policy Research
R. Don Blim, Retired Physician Executive
Noreen M. Clark, University of Michigan Center for Managing Chronic Disease
Christine C. Ferguson, George Washington University School of Public Health and Health
Services
George R. Flores, The California Endowment
Linda P. Fried, Columbia University Joseph L. Mailman School of Public Health
Patricia A. Ganz, University of California, Los Angeles, Jonsson Comprehensive Cancer Center
Lisa I. Iezzoni, Harvard Medical School
Jerome P. Kassirer, Tufts University School of Medicine
Jeffrey Levi, Trust for America’s Health
Katie Maslow, Institute of Medicine
Bernadette Melnyk, The Ohio State University College of Nursing
David O. Meltzer, The University of Chicago Harris School
Anne Newman, University of Pittsburgh Graduate School of Public Health
Marjorie L. Pearson, RAND Health
S. Leonard Syme, University of California, Berkeley, School of Public Health
Lorna E. Thorpe, CUNY School of Public Health at Hunter College
Ed Wagner, University of Washington School of Public Health and Community Medicine
Fredric D. Wolinsky, The University of Iowa College of Public Health
Although the reviewers listed above have provided many constructive comments and
suggestions, they were not asked to endorse the conclusions or recommendations nor did they
see the final draft of the report before its release. The review of this report was overseen by
Antonia M. Villarruel, University of Michigan, and Eric B. Larson, Group Health Research Institute.
Appointed by the National Research Council, they were responsible for making certain that an
independent examination of this report was carried out in accordance with institutional
procedures and that all review comments were carefully considered. Responsibility for the final
content of this report rests entirely with the authoring committee and the institution.
PREPUBLICATION COPY – UNCORRECTED PROOFS
vii
Copyright © National Academy of Sciences. All rights reserved.
Living Well with Chronic Illness: A Call for Public Health Action
Copyright © National Academy of Sciences. All rights reserved.
Living Well with Chronic Illness: A Call for Public Health Action
FOREWORD
Chronic illness in America imposes an enormous and growing burden on individuals,
families, communities, and the nation as a whole. An aging population is one key driver, and
rising rates of obesity are making matters worse. Insufficient physical activity and persistent
smoking in about 20 percent of the adult population contribute to the problem. For those who are
living with chronic disease, access to suitable disease management programs is uneven,
disparities among racial and ethnic groups persist, and shortcomings in the quality of care are all
too common.
Public health programs have made important inroads in the prevention of several types of
cancer, heart disease, and other chronic conditions. However, much remains to be done in
primary prevention, initial treatment, and long-term follow-up to deter the onset of disease,
reduce the incidence of complications, and diminish the severity of illness. This report examines
the role of public health services in accomplishing these goals.
Public health systems have a variety of tools that can be brought to bear on chronic
illness. Some are direct public health functions, such as surveillance and regulation, others
involve outreach to patients and families through education, some entail closer coordination with
those who deliver personal health services, and yet others involve enlisting the cooperation of
diverse leaders in the public and private sectors. Despite substantial gaps in knowledge and
insufficient resources, public health has the capacity to help reduce, manage, and control chronic
diseases. This report shows how.
Coping with chronic illness is not America’s challenge alone. In September 2011, for the
first time, the United Nations took up the topic of chronic diseases as a principal theme at a
plenary gathering. The rising burden of chronic disease affects countries at every position on the
economic spectrum. Each has much to learn from others, recognizing that differences in culture,
conditions and circumstances will demand distinctive solutions. We hope that the report that
follows can help the United States bring new leadership to mitigating the burden of chronic
illness at home and for the global community.
Harvey V. Fineberg, M.D., Ph.D.
President, Institute of Medicine
PREPUBLICATION COPY – UNCORRECTED PROOFS
ix
Copyright © National Academy of Sciences. All rights reserved.
