Systems change: Chronic Disease 101

Plan: Step 2
This process has four elements:
  1. Plan:
       a. Step 1.
       b. Step 2.
       c. Step 3.
       d. Step 4.
  2. Do:
       a. Step 1.
       b. Step 2.
  3. Study.
  4. Act.
Before you begin to work with clinics to increase the use of preventive services, it’s a good idea to familiarize yourself with the subject. Becoming an “expert” (or partnering with one) on chronic disease prevention, guidelines and recommended tests will allow you to speak knowledgeably to the partnering clinics and guide them in their decision-making process.
About chronic disease
Chronic disease is the leading cause of mortality and morbidity in adult Americans.
  • In 2010, more than 50 percent of all deaths were from heart disease, cancer or stroke.
  • Almost half U.S. adults, or 107 million people, reported having at least one of six chronic illnesses in 2008: cardiovascular disease, cancer, chronic obstructive pulmonary disease, asthma, diabetes or arthritis.
  • The management of these conditions is costly to the health care system. For instance, obesity, which can lead to heart disease, stroke, type 2 diabetes and cancer, costs the U.S. $147 billion annually.
Public health, both nationally and locally, has realized the potential in preventing chronic diseases and has launched campaigns to encourage physical activity and healthy eating, as obesity is a major risk factor for many chronic conditions. In addition to public awareness, engaging people at the health care level is key. Under health care reform, preventive services, such as yearly checkups, cancer screenings and cholesterol screening, are now covered by most insurance plans.
Below are examples of screenings that could be incorporated in a primary care visit, depending on the age and health history of the individual. These are general recommendations for average-risk individuals; guidelines may vary depending on an individual’s personal or family history.
Condition-specific resources
  • The American Cancer Society recommends yearly mammograms starting at age 40.
  • Breast cancer screening guidelines are less standardized than those for cervical or colorectal cancer. Check with your local clinic to learn about the practices in your community.
  • The American Cancer Society recommends Pap tests for women every three years beginning at age 21.
  • Beginning at age 30, the preferred way to screen is with a Pap test combined with one for human papilloma virus.  
  • The American Cancer Society recommends screening beginning at age 50 for average-risk men and women; intervals vary depending on type of test.
  • See “Why local public health?” for more information.
Diabetes screening
The American Diabetes Association recommends that all adults 45 and older be considered for diabetes screening by their provider.
  • The U.S. Preventive Services Task Force recommends blood pressure screening for adults 18 and older.
  • The American Heart Association recommends blood pressure screening at regular health care visits or at least once every two years beginning at age 20. 
Body mass index (BMI) screening
The American Heart Association recommends BMI screening at each regular health care visit.
Cholesterol screening
The American Heart Association recommends cholesterol screenings every five years beginning at age 20.
Tobacco screening and referral
The U.S. Preventive Services Task Force recommends that clinicians ask all adults about tobacco use and provide tobacco cessation interventions for those who use tobacco products.