Why Is Chronic Disease an Important Public Health Issue?
Seven of the 10 leading causes of death in the United States in 2005 were chronic diseases—heart diseases, cancer, stroke, chronic lower respiratory diseases, diabetes, Alzheimer's disease, and kidney disease.1 Almost 50 percent of Americans suffer from one or more chronic diseases. The number of people with chronic conditions is increasing rapidly and is estimated to rise to 171 million (nearly half the population) by 2030.2 Chronic diseases such as cardiovascular disease, obesity, and diabetes are among the most prevalent and costly, yet preventable, of all health problems. The medical care costs of people with chronic diseases account for more than 75 percent of the nation's $2 trillion spent on medical care costs.3
The past 30 years have seen a dramatic increase in the prevalence of overweight individuals and obesity. Approximately two-thirds of all US adults are overweight or obese.4 Only 23 percent of US adults and 20 percent of young people eat five or more servings of fruits and vegetables each day.5 More than 60 percent of US adults do not engage in the recommended amount of physical activity, while almost half of youths between 12 to 21 years of age are not regularly active.6,7 Nearly 21 percent of US adults are current cigarette smokers.8 Each day, about 1 300 persons 17 years of age or younger begin smoking on a daily basis.9
What Is the Role of Local Health Departments in Preventing Chronic Disease?
The health status of individuals is closely linked to the communities in which they live.
Local health departments can play a critical role in implementing community-based interventions that have the greatest impact on chronic disease prevention, including interventions that target physical activity and healthy eating. Preventing chronic diseases and creating healthier communities involve implementing policy, systems, and environmental change strategies. Community-based interventions have also proven to be cost-effective. Recent research indicates that an investment of $10 per person per year in proven community-based programs to increase physical activity, improve nutrition, and prevent smoking and other tobacco use could save the country more than $16 billion annually within 5 years. This is a return of $5.60 for every $1 invested.10
What Is the Role of NACCHO and CDC in Supporting Chronic Disease Prevention at the Local Level Through the ACHIEVE Model?
Addressing chronic disease involves collaboration at the federal, state, and local levels. The National Association of County and City Health Officials (NACCHO), as the organization representing local health departments across the United States, is uniquely positioned to identify and address local public health challenges. ACHIEVE (Action Communities for Health, Innovation, and EnVironmental changE) is sponsored by the Centers for Disease Control and Prevention (CDC). Five national organizations have been selected to collaborate with CDC in conducting ACHIEVE. These organizations are NACCHO, the National Association of Chronic Disease Directors, the National Recreation and Park Association, the YMCA of the USA (Y-USA), and the Society for Public Health Education.
During the next 5 years, beginning in 2009, four of these national organizations will select approximately 40 new communities per year (10 per organization) for 3-year periods for a total of at least 200 ACHIEVE communities. In March 2009, NACCHO selected 10 ACHIEVE communities for funding through a competitive application process. These 10 communities are as follows:
- Alexandria, Virginia (Alexandria Health Department)
- Clinton County, New York (Clinton County Health Department)
- Columbia County, Oregon (Columbia Health District-Public Health Authority)
- Cook County, Illinois (Cook County Department of Public Health)
- Island County, Washington (Island County Public Health)
- Klickitat County, Washington (Klickitat County Health Department)
- Muskegon County, Michigan (Public Health Muskegon County)
- New London County, Connecticut (Ledge Light Health District)
- Sacramento County, California (County of Sacramento Department of Public Health)
- Yellowstone County, Montana (RiverStone Health)
These communities are involved in a number of key activities and deliverables, including developing a cross-sector Community Health Action and Response Team, consisting of approximately 10 to 12 local leaders, conducting a local assessment of policy, systems, and environmental change strategies, developing a community action plan (CAP), and implementing the plan during years 2 and 3 of the initiative. Phases of ACHIEVE include commitment, assessment, planning, implementation, and evaluation.
The NACCHO directly supports ACHIEVE communities through ongoing technical assistance, training opportunities, and dissemination of effective tools, resources, and community-based models.
What Is ACHIEVE?
ACHIEVE is designed to enhance local communities' abilities to develop and implement policy, systems, and environmental change strategies that can help prevent or manage health-risk factors for heart disease, stroke, diabetes, cancer, obesity, and arthritis. Specific activities will be directed toward reducing tobacco use and exposure, promoting physical activity and healthy eating, improving access to quality preventive healthcare services, and eliminating health disparities. ACHIEVE fosters collaborative partnerships between city and county health officials, city and county government, tribal programs, parks and recreation departments, local YMCAs, local health-related coalitions, and other representatives from the school, business, health, and community sectors to implement community-based interventions that focus on policy and systems.
Examples of community-based improvements include increased access to and use of attractive and safe locations for engaging in physical activity, revised school food contracts that include more fruits and vegetables and whole grain foods, ordinances that protect children and adults from exposure to secondhand smoke and encourage nonsmoking, implantation of work site wellness programs that encourage healthy behaviors and provide preventive health benefits, and requirements for sidewalks and crossing signals in neighborhoods to make them more pedestrian-friendly.
What Are the Expected Results of ACHIEVE?
In 2008, 10 communities were funded as an ACHIEVE pilot. Early successes from these communities include the following:
- Albuquerque, New Mexico: Used a photo assessment methodology to educate community members about the built environment and worked toward linking alleyways with community gardens.
- Tacoma-Pierce County, Washington: Working to increase opportunities for physical activity among youth. The team is developing joint use policies to allow the use of schools for recreation and exercise by the general public during non–school hours.
- Stark County, Ohio: Has recommended local that work sites create workplace policies to promote employee physical activity during work time and on lunches and breaks.
The ultimate goal of ACHIEVE is to help build healthier communities by promoting policy and environmental change strategies to address chronic disease factors such as tobacco use, physical inactivity, and poor nutrition. ACHIEVE is a community-based, collaborative health improvement process. National organizations and communities will have greater capacity to develop and disseminate tools and strategies for implementation. In addition, ACHIEVE is expected to enhance collaboration among groups of diverse partners at the local, state, and national levels.
For more information on ACHIEVE, please visit http://www.achievecommunities.org.
1. Kung H, Hoyert D, Xu J, Murphy S. Deaths: final data for 2005. Natl Vital Stat Rep.
2. Wu SY, Green A. Projection of Chronic Illness Prevalence and Cost Inflation
. Santa Monica, CA: RAND Corporation; 2000.
8. Centers for Disease Control and Prevention. Cigarette smoking among adults—United States, 2006. MMWR Morb Mortal Wkly Rep.
9. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. Results from the 2006 National Survey on Drug Use and Health: national findings.http://oas.samhsa.gov/nsduh/2k6nsduh/2k6results.pdf
. Accessed March 21, 2008.