physically unhealthy days, mentally unhealthy days, and days with activity limitations in the previous month than people who do not have asthma. Data from the California Health Interview Survey, for example, indicate that about 30 percent of adults with asthma experienced daily or weekly asthma symptoms. In 2005, asthma accounted for 2 million days of missed work among Californians.

Epilepsy, another example, is a chronic neurological condition identified by recurring seizures. Epilepsy can be caused by different conditions that affect a person’s brain, such as stroke, head trauma, and infection, and those with the condition are at higher risk for injuries (both unintentional and self-inflicted) and other chronic illnesses. Epilepsy affects about 2 million people in the United States, which makes it one of the most common neurological conditions. Epilepsy accounts for $15.5 billion in medical costs and loss or reduction in earnings and productivity. Despite medical attention and treatment, more than one-third of individuals with epilepsy continue to have seizures, a situation that significantly affects the quality of life for those living with this chronic illness. In addition, many people who suffer from seizure disorders also live with the burden and risk of a phenomenon known as sudden unexpected death from epilepsy (CDC, 2011).

Chronic illnesses not only impact the lives of millions of people in America but also are a major contributor to health care costs. The medical care costs of people with chronic illness represent 75 percent of the $2 trillion spent annually in the United States on health care (Kaiser Family Foundation, 2010). The substantial costs in terms of the number of lives lost, quality of life diminished, and medical expenditures mean that public health interventions are needed to reduce the burden of chronic disease, especially among those at highest risk (e.g., those with prediabetes, hypertension, high cholesterol) and in preventing further consequences among those with chronic illnesses (secondary prevention).

In 2010, the CDC and the Arthritis Foundation sought assistance from the Institute of Medicine (IOM) to identify population-based public health actions that can help reduce disability and improve functioning and quality of life among individuals who are at high risk of developing a chronic illness and those with one or more chronic illnesses.


The statement of task for this consensus study provides that the IOM will establish a committee to examine the nonfatal burden of chronic disease and the implications for population-based public health action. A set of questions was to be considered for persons with single as well as multiple chronic diseases:

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