As the United States begins to emerge from the COVID-19 pandemic, reformers of all stripes are calling on the nation’s political and business leaders to take this once-in-a-lifetime opportunity to implement meaningful change on many fronts so that the new normal will be better than the pre-COVID status quo.
Among the problems that the pandemic has drawn attention to is the high prevalence of underlying chronic health conditions in the U.S. population. These conditions — including obesity, diabetes, high blood pressure and cardiovascular disease — are more than contributors to worsen COVID-19 outcomes; they are also a growing long-term threat to the country’s health, productivity and national security.
According to the Centers for Disease Control and Prevention, 88 million American adults (1 in 3) have prediabetes, 60% of adults in the U.S. have a chronic disease and 40% have more than one, and these chronic diseases are the leading drivers of America’s soaring health care costs ($3.8 trillion in 2019).
The COVID-19 pandemic grabbed our attention because the impact was immediate and we all felt at risk. Even most people who were not personally concerned about the danger to their own health were at least conscious of the risk of coming into contact with the virus and needing to quarantine or, worse, passing the virus on to someone more vulnerable. We responded quickly to this new infectious disease and became hypervigilant.
It’s time to transfer some of that same urgency to addressing chronic noncommunicable diseases. Pre-COVID, noncommunicable diseases were responsible for nearly 90% of deaths in the U.S. While provisional data from the CDC identify COVID-19 as the third-leading cause of death in 2020, the first and second were heart disease and cancer, respectively, with stroke, chronic lower respiratory disease and diabetes also in the top 10.
Many of these diseases (and the physical, mental and economic costs they entail) are preventable. The World Health Organization states that eliminating the four major behavioral risk factors for chronic disease — unhealthy diets, physical inactivity, tobacco use and harmful use of alcohol — would prevent 80% of all heart disease, stroke and type 2 diabetes and 40% of cancer.
In many ways, the rising tide of chronic disease is similar to the issue we face with climate change: while we all recognize that it’s serious, and we know we need to act, because the impact is not immediate it’s hard to overcome inertia and introduce the significant structural changes that would really make a difference.
COVID-19 generated a burst of attention for communicable disease, but there’s no equivalent pressure forcing immediate action on noncommunicable disease. Social scientists and psychologists who study risk perception have long observed how we react strongly to sudden, acute risks (say, a wildfire bearing down on our town) but become habituated to chronic, ongoing threats (gradual warming of the planet or the risk of car accidents, for example).
But we don’t need to become desensitized and accept a high level of chronic disease and its spiraling costs to health insurers as inevitable. The pandemic proved that both individuals and organizations can change their habits to protect people’s well-being.
President Biden’s recently proposed American Families Plan includes a variety of provisions aimed at reducing the financial impact of illness and making health care more affordable, such as the establishment of a national comprehensive paid family and medical leave program and reducing health insurance premiums and deductibles for those who buy coverage on their own. However, with roughly half of Americans obtaining their health insurance through their employer, significant efforts are needed to decrease corporate health care costs as well.
If we really want to reduce costs, we need to tackle the problem at its root by reducing the need for care. We must take a step back and look for ways to support early intervention before people develop preventable chronic conditions.
The COVID-19 pandemic has primed corporate America for a mindset shift in terms of health care plan design and benefits. Companies recognize the need to place a higher priority on employee health and wellbeing, and Congress should offer tax credits to incentivize organizations to turn these good intentions into reality.
Encouraging the adoption of proven evidence-based preventive care benefits that address unhealthy behaviors before they lead to chronic disease will have a much greater long-term impact than tinkering with the edges of condition management for the health insurance market.
We can’t let complacency set in as soon as the pandemic is over, because business as usual is unsustainable and threatens America. Let’s leverage the lessons learned from COVID-19 to prevent both communicable and noncommunicable disease — after all, there is only one health we need to safeguard. We must act now to help keep the American workforce healthy, reduce employer health care costs, and prevent the increasing incidence of chronic disease from overburdening the health care system and the economy.
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