Chronic diseases have become the leading cause of morbidity and mortality among the population and of cost escalation in health insurance premiums and health care costs in the United States over the last several years. This chronic disease epidemic has become the most serious medical threat to ever face the nation, and it is going to get worse until we as a nation decide to prevent it from growing. Reasons for this alarming increase in chronic diseases are the increase in high-risk health behaviors and a paradigm of medicine that concentrates on the cure rather than the prevention of disease.

Chronic diseases are responsible for over 75 percent of U.S. health care costs and are rapidly reducing the quality of life for a very large segment of the older population. These diseases can begin at a very early age, can continue to inflict damage in later life, and result in complications that cause pain, suffering, and quite often premature death.

We have not yet responded appropriately to the growing epidemic of chronic diseases and their complications, which is only going to get worse as the population continues to age. It is critical that all parts of the entire health care system work together with communities to develop a chronic disease plan of action to deal with these diseases and work on preventing the development of new cases in the future.

This collaborative approach to the chronic disease epidemic requires a new model for providers, insurers, and patients to follow. This new model can benefit from drawing on recent business models that have been successful in change management and program execution. Several business models that could be applied to health promotion programs were discussed in this chapter. The model for improvement was then applied to the problem of overweight and obesity, which is an underlying cause of numerous chronic diseases and their complications, not only in the United States but also around the world.



body mass index (BMI)


chronic care model

chronic disease


Deming cycle of PDSA (Plan, Do, Study, Act)


evidence-based system

hemorrhagic stroke

ischemic stroke

model for improvement



self-management support


type 2 diabetes

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