Prevention Agenda 2013-2018: Preventing Chronic Diseases Action Plan

Introduction (Read More)

Chronic diseases such as cancer, diabetes, heart disease, stroke and asthma are conditions of long duration and generally slow progression. Chronic diseases are among the leading causes of death, disability and rising health care costs in New York State (NYS). Specifically, they account for approximately 70 percent of all deaths in NYS and affect the quality of life for millions of New Yorkers, causing major limitations in daily living for about one in ten residents. Costs associated with chronic diseases and their major risk factors consume more than 75 percent of our nation's spending on health care.1

However, chronic diseases are also among the most preventable. Three modifiable risk behaviors - lack of physical activity, unhealthy nutrition, and tobacco use - are largely responsible for the incidence, severity and adverse outcomes of chronic disease. The World Health Organization has estimated that if the major risk factors for chronic disease were eliminated, at least 80 percent of all heart disease, stroke and type-2 diabetes would be prevented, and more than 40 percent of cancer cases would be avoided.2

As such, increasing physical activity, improving nutrition, and decreasing tobacco use form the core of the Preventing Chronic Diseases Action Plan for the New York State Prevention Agenda. Within this framework, the Action Plan places emphasis on three key areas: 1) health promotion activities to encourage healthy living and limit the onset of chronic diseases; 2) early detection opportunities that include screening populations at risk; and 3) successful management strategies for existing diseases and related complications. In addition, because of well-documented and widespread disparities in chronic disease incidence and mortality among vulnerable populations, addressing these health disparities is a focal point for the chronic disease action plan.

It is vital that NYS address chronic diseases and their causes to effectively stem the tide of escalating health care costs and ensure that New Yorkers lead healthy and productive lives. Without doing so, these persistent conditions will leave in their wake a growing burden of disability, compromised quality of life, and death, with well-considered and concerted action, could have been prevented.

Sections of the Preventing Chronic Diseases Action Plan

The Preventing Chronic Diseases Action Plan contains three Focus Areas:

Reducing obesity and tobacco use were selected as the first two focus areas because they are the leading causes of preventable death. Both conditions disproportionally impact low-income and minority communities, and both obesity and tobacco use directly and significantly contribute to other chronic diseases, including diabetes, cancer, heart disease, arthritis, asthma and others. Increasing access to high-quality chronic disease preventive care and management was selected as the third focus area, in recognition of the critical role of health care and community-based organizations in reducing the devastating impact of chronic diseases through prevention, screening, early detection, treatment, and self-management support. Achieving equitable outcomes and enhancing the well-being of vulnerable communities is integrated into all three focus areas.

Objectives and Indicators

Each focus area, and its accompanying goals, includes the objectives and indicators that will be used to measure the State's progress. A subset of these objectives will be tracked and published electronically in yearly reports for the State and counties (where county data is available); these objectives are marked as a Prevention Agenda (PA) Tracking Indicators. In addition, indicators that will track the State's progress towards reducing health disparities are marked as a Health Disparities Indicator. Appendix 1 includes a list of the indicators with the data source; frequency of data collection; whether the data are available at the State, county or other level; and whether the data are available for subpopulations.

Recommended Interventions for Consideration

The Action Plan recommends interventions to address each focus area and related goals. Many of these interventions for consideration are intended for community level action; which interventions are selected by a community will depend on that community's needs and circumstances.
The interventions listed were selected after taking into account the interventions' evidence base, potential to address health inequities, ability to measure success, potential reach, potential for broad partner support and collaboration, and political feasibility. Each intervention refers to key documents that provide its evidence base and/or source. These references also show how the intervention aligns with and builds on existing Federal and State recommendations and initiatives. Appendix 2 summarizes these key documents.

Interventions (abbreviated) by Level of Health Impact Pyramid

Each recommended intervention corresponds to one of the five tiers of the Health Impact Pyramid, a framework based on potential reach and the relative impact of interventions at each tier.3 At the base are efforts to address socio-economic determinants of health (Tier 1). In ascending order are interventions that change the context to make individuals' default decisions healthy (Tier 2), clinical interventions that confer long-term protection (Tier 3), ongoing direct clinical care (Tier 4), and health education and counseling (Tier 5). Interventions focusing on lower levels of the pyramid tend to be more effective because they reach broader segments of society and require less individual effort. Implementing the interventions at each level can achieve the maximum sustained public health benefit.

Distribution of Interventions and Activities by Sector

All organizations, or sectors, must play a role to effectively implement these interventions. These sectors include the health care delivery system; employers, business and unions; media; academia; community-based health and human service agencies; State and local government and non-governmental public health; other government agencies; policymakers and elected officials; and communities; and philanthropy. Activities taken by these different sectors to accomplish the objectives are listed for each goal area.

Note: The Prevention Agenda 2013-2017 has been extended to 2018 to align its timeline with other state and federal health care reform initiatives.