Preventing Chronic Disease
by Activating Grassroots Change
At A Glance
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“Turning the tide in chronic disease will require
changes in our communities
that support health where we live, learn, work, and play.”
Janet L. Collins, PhD
Director, National Center for Chronic Disease Prevention and Health
Promotion, Centers for Disease Control and Prevention
A National Chronic Disease Crisis: The Time to Act is Now
Our nation faces a crisis in the burden of chronic disease. Chronic
diseases are the leading causes of death in our nation, accounting for 70%
of all deaths. Chronic diseases such as heart disease, stroke, cancer,
diabetes, and arthritis cause suffering and limitations to function, health,
activity, and work that affect the individuals with these conditions as well
as their families. For example,
- Heart disease is a leading cause of premature, permanent disability
in the U.S. workforce, and 66% of heart attack victims never fully
- Sixty percent of leg and foot amputations unrelated to injury are
among people with diabetes. Diabetes also is the leading cause of new
cases of blindness and kidney failure in adults.
- Arthritis, the nation’s most common cause of disability, results in
activity limitations for nearly 19 million Americans. These limitations
include difficulty lifting or carrying 10 pounds (e.g., a bag of
groceries or a grandchild) or grasping small objects (e.g., a pen or
door handle). Arthritis also causes work limitations for 1 in 3
working-age adults (18–64 years) with arthritis.
A significant portion of U.S. health care costs is spent on treating
chronic diseases. Health care costs for people with chronic conditions
account for more than 75% of the $1.4 trillion spent on annual medical care
costs. As a result, the national chronic disease crisis is central to the
future of health care in our nation. This issue is of great concern among
policy makers and those who pay for public and private health insurance
Preventable risk factors such as tobacco use, physical inactivity, and
poor diet contribute greatly to the development and severity of many chronic
diseases. Community and national leaders are concerned about trends in these
risk factors and their future impact on our nation’s health.
- Over the past 30 years, the rates of overweight have more than
doubled in children and tripled in adolescents. About one-third of U.S.
adults are obese, and another one-third are considered overweight.
- In the last 15 years, the number of people in the United States with
diagnosed diabetes has more than doubled, reaching 14.6 million in 2005.
Researchers predict that one-third of all children born in the year 2000
will develop type 2 diabetes during their lifetime.
- Recent surveys indicate that the rate of decline in smoking rates
may have stalled among both youth and adults.
Serious and persistent health disparities continue to exist in chronic
disease. For example,
- Heart disease death rates are 30% higher for African Americans than
for whites, and stroke death rates are 41% higher.
- Diabetes rates are 2.5 times higher among American Indians and more
than twice as high among Alaska Natives compared with whites.
Over the past several decades, the United States has undergone profound
societal changes that have made it increasingly difficult for adults,
children, and families to engage in the healthy behaviors that can prevent
and control chronic disease. These new challenges include larger portion
sizes, poor access to fresh fruits and vegetables, less physical education
in schools, labor-saving devices, sedentary jobs, nonwalkable communities,
urbanization, and stress. They also include increased television viewing and
other “screen time,” businesses unable to afford adequate health insurance
plans, a “sandwich generation” caring for both their children and their
aging parents, fear of crime that keeps people from being active outdoors,
and a persistence of the social issues that drive health disparities.
Local communities are concerned about trends in chronic diseases and have
responded with a groundswell of energy, ideas, and the will to make the
local changes needed to reverse trends in the chronic disease burden across
There is much that local communities can do. To a large extent, the
patterns of people’s lives and the barriers they confront from the moment
they wake up to the time they go to bed set the course of risk for chronic
disease. Turning the tide in chronic disease will require mobilizing
resources and changing the places, organizations, and systems that touch
people’s lives every day. For example, we need changes in our schools, work
sites, faith-based organizations, and community groups; healthy and
affordable food options in local grocery stores and restaurants; safe places
where people can be physically active; effective preventive health care; and
transportation systems that support walking and biking.
Key decisions rest in the hands of local decision makers. To support
these decisions, CDC, state health departments, national organizations with
extensive community reach, and a wide range of local leaders and groups are
collaborating to emphasize, activate, support, and spread local change
across our nation.
CDC’s Role in Activating Local Change
Over the past 2 years, CDC has convened national experts and leaders in
community health promotion to chart a course that will accelerate national
and state strategies in chronic disease through local change. Community
mobilization will be key to reversing the looming crises in the national
chronic disease burden and health disparities. All of CDC’s efforts in this
area are conducted in close collaboration with partners who can spread
change widely, such as state health departments, local health departments,
community-based organizations, faith-based organizations, national
associations with local affiliates, and decision makers across a wide range
of sectors that influence community health.
CDC is convening teams of leaders from communities across the country to
assess what can be done locally. Community leaders from multiple sectors
receive training, tools, and guidance to develop local action plans. When
they return to their communities, they receive ongoing assistance to carry
out these plans and are linked with a consultation and learning network that
includes their state chronic disease leaders, national experts, and peer
communities. In 2008, CDC will engage with local teams on topics that
address changing communities, health disparities, and older adult health.
Racial and Ethnic Approaches to Community Health Across the United
States (REACH U.S.)
CDC’s REACH U.S. program has produced improvements in health and reductions
in health disparities in communities that face serious community health
problems. In fiscal year 2007, CDC launched Centers of Excellence in the
Elimination of Health Disparities (CEEDs) to disseminate innovative
strategies developed in REACH communities and to train and mentor new
communities. REACH’s Action Communities also continue to implement
successful local strategies.
CDC’s Steps Program
Communities supported through CDC’s Steps Program are taking local action to
reverse trends in risk factors for obesity and chronic disease. They are
showing what local communities can do and are producing local success.
Hundreds of communities have requested CDC training and support. CDC is
collaborating with the YMCA of the USA, state health departments, the
National Association of Chronic Disease Directors, the National Association
of City and County Health Officials, and other organizations to spread the
impact of the Steps Program.
Pioneering Healthier Communities
The YMCA of the USA is blazing new trails in community health. It is
mobilizing its vast network—which has established roots in communities
across our nation—to convene key local leaders to improve health and
confront the national crisis in obesity and chronic disease.
The YMCA of the USA has developed innovative models for community change
and has convened, trained, and supported action teams of key leaders in 64
communities through its Pioneering Healthier Communities Program. By the end
of 2008, nearly 100 communities will be impacted. CDC provides guidance and
support as local leaders make important and long-lasting changes to their
Spreading Change Across the Nation
CDC is disseminating effective strategies for local change and key
lessons learned from local communities. CDC is providing communities with
tools, guidance, and support for effective local action to turn the national
tide in chronic disease and reduce health disparities. An ever-widening
network of communities is ready to take action with CDC’s support. To date,
more than 170 communities have been impacted, and hundreds more have
Communities in Action: Turning the Tide at the Grassroots Level
Empowering Minority Communities to Seek Better Health
In south central Los Angeles, local African American communities came
together to address gaps in local access to healthy food options. The local
REACH coalition, led by the Community Health Councils of Los Angeles, played
a key role in assessing the problem and developing effective solutions.
Community leaders and local policy makers are now taking action by creating
business incentives to increase access to healthy food and using community
approaches to decrease local exposure to unhealthy foods.
In New York City, the Bronx Health REACH Coalition implemented a
nutrition and fitness initiative to improve residents’ access to healthy
foods. City schools have switched from whole milk to low-fat milk,
neighborhood grocers carry low-fat milk and healthier snacks, and local
restaurants highlight their healthy menu options. The coalition also has
achieved changes within influential local faith organizations, which are now
changing their practices to help local residents eat healthier diets, be
more physically active, and control chronic diseases such as disease and
Linking Health Systems to the Community
In South Carolina, the REACH Charleston and Georgetown Diabetes Coalition is
working to improve diabetes care and control for more than 12,000 African
Americans with diabetes. The coalition has worked with local community
members to assess reasons for disparities in health and to seek
community-driven solutions. The coalition also has taught community members
how to navigate the health care system. In addition, it created a system to
ensure that people have access to the community resources and support they
need to make lifestyle changes and control the effects of diabetes.
Results have been dramatic. A 21% gap in annual blood sugar testing
between African Americans and whites has been virtually eliminated.
Lower-extremity amputations among African Americans with diabetes also
decreased sharply. In Charleston County, the rate of amputations among
African American men with diabetes who were hospitalized decreased nearly
54% over 7 years. In Georgetown County, the rate decreased 54% over 4 years.
Partnering with Work Sites to Promote Better Health
Work sites have much to gain from participating in community action plans
designed to improve community health. Through the Steps Program in Austin,
Texas, the local health department worked with a prominent local employer,
Capital Metro, to assess and implement a comprehensive work site wellness
program to reduce diabetes and heart disease risk factors among employees.
The program’s success led to decreases in health care costs and employee
absences and improvements in participants’ health and healthy behaviors.
Employee absences decreased 44%; rising health care costs increased by only
9% annually, compared with 27% in previous years.
Helping Native American Nations Address Health Disparities
CDC’s community agenda has given Native American nations unprecedented
opportunities to address severe health disparities in their communities.
Through the Steps Program, the Cherokee Nation implemented CDC’s School
Health Index: A Self-Assessment and Planning Guide in 19 schools with
predominantly American Indian populations. All schools made significant
changes in the school environment, such as developing overall wellness
policies, offering healthier choices in vending machines and cafeterias, and
providing access to exercise facilities after school. Nine schools
implemented 24/7 tobacco-free policies.
Getting Healthy Foods to Underserved Communities
In Pittsburgh, Pennsylvania, low-income children and families have access to
low-cost fruits and vegetables as a result of the YMCA of the USA’s
Pioneering Healthier Communities initiative. This initiative convenes and
supports leadership teams from local communities to assess local conditions
that may be increasing chronic disease rates, and then to make widespread
and long-lasting changes. The PHC leadership team in Pittsburgh created a
way for local after-school programs to buy low-cost fruits and vegetables.
As a result, 5,000 children from diverse backgrounds and 1,000 low-income
teenagers now have access to healthy foods each week. Local after-school
programs also ensure that participants have 45–60 minutes of physical
activity each day.
Ensuring Physical Activity in Schools and Child Care
In Clearwater, Florida, key leaders on the Pioneering Healthier Communities
leadership team decided to lead by example. As part of the team’s community
action plan, the two largest providers of after-school programs in the area
(R’Club Child Care, Inc. and the YMCA of the Suncoast) decided to provide
all children in their programs with 30 minutes of physical activity a day.
As a result of this leadership, the county licensing board now requires
that all such programs in Pinellas County (which includes Clearwater)
provide children with at least 30 minutes of physical activity 5 days a week
in order to be licensed. In addition, the leadership team provided
information and concepts that played a critical role in the passage of a
state law that requires all elementary schools to provide 30 minutes of
daily physical education 5 days a week. As a result of these changes,
children across Pinellas County are now achieving the recommended 60 minutes
of daily physical activity.
Turning the tide on chronic disease will require changes in our
communities that support health where we live, learn, work, and play.
Working with key partners, CDC will activate these changes in an
ever-widening network of communities that are ready to take action. CDC will
continue to develop and disseminate successful strategies to address chronic
disease and health disparities at local levels. CDC will synthesize and
translate lessons learned and successful models into tools, guides,
training, and interventions, and we will make these resources widely
For more information please contact
Centers for Disease
Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
4770 Buford Highway NE, Mail Stop K–45, Atlanta, GA 30341-3717
Telephone: 770-488-5269 • Fax: 770-488-5964 •
REACH Web site: http://www.cdc.gov/reach
• Steps Web site:
Page last modified: March 11, 2008
Content source: National Center for
Chronic Disease Prevention and Health Promotion