Summer 2003 Issue
Tackling Chronic Diseases
A conversation with Dr. James Marks
Prevention Saves Lives & Money
Preventing health problems is one of the few known ways, if not the only way, we can stem rising health care costs. Practical interventions exist for controlling and preventing many of today’s chronic diseases.
- Engaging in regular physical activity is associated with taking less medication and having fewer hospitalizations and physician visits.
- One year after quitting smoking, excess risk for heart disease is reduced by half; 15 years after quitting, an ex-smoker’s risk for heart disease is about the same as that of a lifelong non-smoker.
- Each $1 spent on diabetes outpatient education saves $2 to $3 in hospitalization costs.
Chronic Disease: How We Help
The CDC Foundation is currently involved in several programs aimed at reducing the burden of chronic disease.
- Avon - CDC Foundation Mobile Access Program funds several mobile mammography vans that will improve the accessibility to and facilitate the use of breast cancer and related screening services by underserved women.
- Two CDC Foundation REACH 2010 projects, funded by The California Endowment, support community approaches to eliminate racial and ethnic disparities in health, including heart disease, breast, cervical and other cancers in the state of California.
- The State and Community Partnerships to Reduce and Prevent Tobacco Use funded by the American Legacy Foundation promotes tobacco prevention and control intervention in several geographic areas in the United States.
“If we are concerned about the rising costs of health care, we will have to learn how to better deal with chronic diseases.”
- Dr. James S. Marks
Director of CDC’s National Center for Chronic Disease Prevention and Health Promotion
Dr. James Marks, M.D., M.P.H., EIS ’76, has dedicated his career to improving the quality of life for Americans through the prevention of chronic disease. As director of CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), he oversees the nation’s leading agency for the prevention of premature death and disability from chronic diseases.
A former pediatrician and CDC-trained Epidemic Intelligence Service officer (1976-78), Dr. Marks came back to CDC in 1980 to fulfill his desire to conduct prevention research and soon landed in the Center for Health Promotion and Education – now the NCCDPHP. For over two decades Dr. Marks has worked tirelessly on some of the nation’s most pressing health problems including tobacco use, obesity and diabetes.
What led you to focus your career on chronic diseases?
In the 80s when I rejoined CDC, there was very little being done in chronic diseases. I realized the most burdensome, and arguably the most preventable, diseases are those in the chronic area. This seemed like a field in which I could effect the most change.
What defines a chronic disease?
Chronic diseases have generally accepted characteristics, although they don’t necessarily hold true for each one. One is duration - a disease that lasts a long time. Another is that chronic diseases are generally non-infectious in origin and unlikely to be cured. Some examples are diabetes, hypertension and heart disease.
What are some of the trends in chronic diseases?
A positive trend is the decline in the rate of cancer and cancer mortality over the last few years. We have also started to see a decline in the number of children using tobacco after a real epidemic in the late 80s and 90s. Unfortunately we haven’t had as much success with reducing tobacco use in adults. Another negative trend is the increase in the number of cases of diabetes. Obesity is probably the biggest risk factor contributing negatively to many of these trends.
Which of these trends concerns you the most?
Probably the obesity trend. I see that so much of the force behind the increase is not something that can be corrected by today’s health care or public health systems. It is more about how we eat and the choices that we have. It is about the fact that physical activity is more difficult to incorporate into our daily lives. For example, in Atlanta, most kids who live within a mile of school are driven there rather than walk. Sidewalks and stairs are becoming less common. These are also issues for communities elsewhere.
What will the economic impact of chronic disease be for the United States?
The United States cannot effectively address escalating health care costs without addressing the problem of chronic disease. The medical care costs of people with chronic diseases account for more than 75 percent of the nation’s $1 trillion of health care spending. Not including the costs of inflation and new technology, health care spending will increase by 25 percent between 2000 and 2030 simply because a larger percentage of the population will be older than 65.
Couple that with the fact that older adults depend on Medicare and Social Security - and this is paid for by younger workers. By 2030 there will only be two workers paying taxes to support one older adult on Social Security and Medicare. Right now we have nearly four workers supporting every older adult. Preventing health problems is one of the few known ways, if not the only way, we can stem rising health care costs.
You have been at this for a while. What has kept you at CDC for so long?
I love it here. CDC is the kind of place where you can be idealistic but also potentially very effective in changing the health of the world.
What are your interests beyond CDC?
Old music - I collect rock & roll records from the 50s and early 60s.
-Karen McDonald