Junk Capitalism: Combating America’s Chronic Disease Epidemic
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John is a 56-year-old who presents to an emergency room with fever and a painful leg. He gets diagnosed with an extensive leg infection. His bloodwork shows that his sugar is extremely high. He was not aware he had diabetes and that it increased his risk of infection. He hasn’t been to the doctor in a decade. His employer provides health insurance but he can’t afford the co-pay. When he tried to get an appointment at a doctor’s office the next available appointment was in three months. John is also obese—likely due to his desk job, a diet of mostly fast food and processed foods, and not having a safe place in his neighborhood to exercise. The nearest grocery store to his home doesn’t carry much fresh produce and what they do have he can’t afford. He has family members with diabetes, but doesn’t really understand the implications of his new diagnosis. The severity of his infection necessitates an expensive hospitalization and lost productivity given his work absence.
John’s story is not unique. Six out of 10 Americans have one chronic disease and four out of 10 have two or more chronic diseases that account for ninety percent of the $4.5 trillion annual health care costs in the nation. Reducing this burden is critical for saving lives and reducing morbidity, lost productivity, and health care costs. Yet, effectively combating the nation’s chronic disease epidemic necessitates prioritization and significant investment in addressing (PDF) all the contributing factors—including lifestyle and environmental factors, low health literacy, ineffective approaches to preventative care, and poor health care access.
Chronic diseases are health conditions that last six months or longer, although mostly preventable they are not curable, necessitate ongoing medical care, and often negatively impact a person’s daily life. The most common chronic diseases in the United States are also among the leading causes of death in the nation, including heart disease, stroke, cancer, emphysema, chronic kidney disease, and Alzheimer’s disease. Obesity, diabetes, and high blood pressure are risk factors for heart disease, stroke, and chronic kidney disease. Genetics and environmental and lifestyle factors contribute to a person’s likelihood of acquiring these risk factors.
Effectively combating the nation’s chronic disease epidemic necessitates prioritization and significant investment in addressing all the contributing factors.
The United States has the greatest rate of people with multiple chronic conditions in spite of much higher rate of health care spending in comparison to other wealthy countries. In 2024, more than 23 percent of U.S. adults reported experiencing a mental illness—often considered a chronic disease that can worsen other chronic diseases. Mental illness can be amplified by other chronic conditions.
Although some chronic diseases can be genetically inherited, advancements in gene therapy to completely “reverse” chronic illnesses are not possible yet. However, the combination of addressing environmental and lifestyle factors, improving health education and disease prevention, and increasing health services capacity and access are effective strategies that collectively can help reduce the burden of chronic disease in America. The following are actions that should be taken to combat this epidemic:
Investing in “Smart” Disease Prevention
Although investments in preventative care in the United States have declined over time, the United States still spends more on disease prevention than other wealthy nations. The fact that the chronic disease epidemic persists despite significant expenditures on prevention may indicate that the solution may not lie in more spending on prevention but in “smarter” spending. More effective interventions may be needed, or prevention strategies may need to focus on the highest risk populations—for example, those with a family history of chronic disease. Exposures such as tobacco products, alcoholic beverages, and other drugs of abuse that are risk factors for chronic diseases need to be the focus of disease prevention campaigns coupled with higher levels of taxation on the sales of such products to disincentivize their use. Further, the most effective disease prevention “messengers” for different populations need to be identified and leveraged, including employers, businesses, educational institutions, faith-based communities, emergency medical services, and social media influencers.
About nine out of 10 American adults have low health literacy—that is they lack the ability to understand health-related information. Low health literacy is associated with poor health outcomes. Boosting health literacy in the United States may require amplifying health education efforts in K—12 educational settings, through employers, health insurance vendors, places of worship, and campaigns funded through public-private collaboration. Higher health literacy may also lead to disease prevention efforts being more effective as the population’s understanding of health and health care increases.
Facilitating Adoption of Healthy Diet and Exercise
Aside from impressing the need for a healthy diet and exercise through promoting health literacy and disease prevention, Americans need access to affordable, healthy foods. As long as fast food and highly processed foods are cheaper than fresh produce, many will choose less healthy options.
For some Americans the cost of healthy foods may not be an issue, but access is. Some communities in the United States are “food deserts” with no grocery stores with fresh produce for many miles. Policies in various states that support the establishment of grocery stores or farmers markets in these zones should be evaluated and widely adopted across the nation.
Importantly, public health campaigns need to address America’s addiction to ultra-processed foods head-on given that 60 percent of calories consumed by many Americans come from ultra-processed foods compared to 14 to 44 percent in Europe.
Communities also need safe and accessible locations for exercise. In areas where exercising outdoors is not safe, or not possible due to very high or low temperatures, investments need to be made in developing well-ventilated indoor spaces for year-round exercise. Employers should be incentivized—for example, through tax breaks—to provide opportunities for movement and exercise in the workplace as these can increase both employee health and productivity.
Increasing Health Services Capacity and Access
In 2024, about 83 million people lived in areas with insufficient access to primary care. Inadequate access to primary care can result in missed opportunities to detect and treat risk factors for chronic diseases. For example, high blood pressure may go undetected resulting in cardiac disease or stroke with increased morbidity, mortality, and health care costs. Use of telehealth and mobile clinics can help increase primary care and behavioral health capacity and access especially in underserved areas—such as rural communities and some urban centers—across the country.
In 2024, about 83 million people lived in areas with insufficient access to primary care. Inadequate access to primary care can result in missed opportunities to detect and treat risk factors for chronic diseases.
The nation’s high burden of chronic disease is juxtaposed against its place as a leader in understanding the root causes of these conditions and the best ways to prevent and treat them. In order to combat America’s chronic disease epidemic related policies need to be rooted in research and scientific evidence produced by the United States and other nations. Research is needed to identify the most cost-effective solutions so that investments in health and health care produce improved health outcomes at the best possible price. Through public-private partnerships, federal, state, and local government should institute multi-front policies that address the root causes of chronic disease in the United States.
Finally, the country’s chronic disease epidemic has been decades in the making. Any plans to reverse course will need to acknowledge that there is no silver bullet, that change will not happen overnight, and that big investments are needed now for a healthier, more prosperous America in the future.
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