• The economic consequences of chronic illnesses to individuals, families, the health care system, and the nation;

• The development and incorporation of conceptual models, created by the committee, as well as borrowing from the Centers for Disease Control and Prevention and sources, to provide a more detailed framework for the overall discussion and the major issues, including public health disease control, economics, and both clinical and public health interventions;

• A concerted approach to understanding the dimensions of prevention as they relate to chronic disease control in the community;

• A wide spectrum of chronic diseases, their clinical stages, their patterns and anticipated course, the common or cross-cutting burden and consequences of living with chronic illness, the populations that experience chronic illnesses disproportionately, the effect of comorbidity, and the adverse effects of clinical treatment. Appendix A, on depression and chronic medical illness, supports this discussion;

• A set of exemplar diseases, health conditions, and impairments for consideration to advance the next generation of chronic disease management programs from a public health perspective, with an explanation of the difficulties in determining a set of diseases that should be the focus for public health action;

• A detailed account of how to improve surveillance in order to better assess health-related quality of life and to plan, develop, implement, and evaluate public health policies, programs, and interventions relevant for individuals living with chronic illness;

• A discussion of the role of public health and community-based interventions for chronic disease management and control, along with examples and designation of venues in which evidence-based effective programs could be located. This discussion is supported by Appendix B, on new models of community-based care for people with chronic illness;

• A consideration of the importance of federal policy in enhancing chronic disease control, including an emphasis on the Affordable Care Act and related legislation, as well as exploring the Health in All Policies and the Health Impact Assessment approach, and how the execution of these laws and policies can be used to enhance public health strategies to improve living with chronic illness; and

• An assessment of the critical role of aligning public health and non–health care community organizations as a system change to better control chronic diseases and improve quality of life and health outcomes in patients living with them.



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