In 1998 Sharon Janis and her husband took a month-long vacation in Europe to celebrate their retirement. Janis, then 54, had been a branch manager for a water and power company in Los Angeles; her husband, a high-school history teacher. It was a beautiful spring day in Paris when they visited the Louvre, but their idyllic outing suddenly shattered when Sharon fainted and fell down a flight of stairs. The diagnosis: type 2 diabetes, the chronic illness that had killed her father.
A short, obese man who owned a deli, Janis's father often came home with high-fat, high-calorie goodies: macaroni and cheese, pastrami, cheesecake. Janis was heavy as a child, and throughout her adult life she kept piling on the weight—reaching 175 pounds in her early 20s and topping 265 by the time she turned 40. "I never gave a thought to what I was doing to my body," she says, even as she watched her father suffer from one diabetes-related illness after another. He had one leg amputated and was scheduled to have the second one removed when he lapsed into a coma and died.
But the fall at the Louvre scared Janis. The next month she accompanied her mother, who was also a diabetic, to a new chronic-disease self-management workshop developed by Stanford University, which offered everything from diet advice to tips on communicating with doctors. Midway through the six-week workshop, after listening to the stories and struggles of other patients who had arthritis, diabetes, and hypertension, Janis realized that if she didn't take charge of her health, "I could end up like my father." Or her mother, who died this past August from diabetes-related heart failure.
Chronic diseases are now the leading cause of disability and death in the United States, with seven in ten deaths each year attributed to such illnesses as cancer, heart disease, diabetes, and stroke. About 133 million Americans—nearly one in two adults—live with at least one chronic disease, and more than one in ten have three or more.
The costs are staggering. Chronic disease accounts for 75 percent of the more than $2 trillion spent on health care each year in the United States. According to the Arthritis Foundation, arthritis alone affects 46 million Americans and costs $128 billion annually in medical costs and lost productivity. Coronary heart disease, which afflicts 16.8 million Americans, costs some $165 billion a year.
Until our health care system improves care for those with chronic illnesses, we'll never get a handle on costs.
Until the mid-20th century, infectious diseases such as diphtheria, polio, meningitis, and chicken pox posed the greatest health threat to society. The advent of vaccines, antibiotics, and more sanitary living conditions greatly reduced mortality and increased life expectancy. But as people began living longer, chronic diseases—ongoing, generally incurable medical conditions—began to replace acute illnesses as the nation's main health care challenge.
Despite this shift, the U.S. health care system is still largely designed to treat patients with acute medical problems. "At no point in medical school are physicians exposed to patients with chronic illness, except for acute episodes leading to hospitalization," says Michael Lockshin, M.D., a Harvard Medical School graduate and head of the women and rheumatic disease center at New York City's Hospital for Special Surgery. The result: Many patients shuffle from doctor to doctor in search of relief from the many complications of their chronic illnesses.