BOX S-1
Statement of Task

The Statement of Task for this consensus study provides that the IOM establish a committee to examine the nonfatal burden of chronic disease and the implications for population-based public health action.

Questions to be considered by the committee for persons with single as well as multiple chronic diseases include

1. What consequences of chronic diseases are most important (criteria to be decided and justified by the committee) to the nation’s health and economic well-being?

2. Which chronic diseases should be the focus of public health efforts to reduce disability and improve functioning and quality of life?

3. Which populations need to be the focus of interventions to reduce the consequences of chronic disease including the burden of disability, loss of productivity and functioning, health care costs, and reduced quality of life?

4. Which population-based interventions can help achieve outcomes that maintain or improve quality of life, functioning, and disability?

• What is the evidence on effectiveness of interventions on these outcomes?

• To what extent do the interventions that address these outcomes also affect clinical outcomes?

• To what extent can policy, environmental, and systems change achieve these outcomes?

5. How can public health surveillance be used to inform public policy decisions to minimize adverse life impacts?

6. What policy priorities could advance efforts to improve life impacts of chronic disease?

7. What is the role of primary prevention (for those at highest risk), secondary, and tertiary prevention of chronic disease in reducing or minimizing life impacts (e.g., preventing diabetes in pre-diabetics, preventing incidence of disability in people with arthritis, preventing recurrence of cancer, managing complications of cardiovascular disease)?

Chronic diseases related to congenital disorders, infectious diseases, substance abuse, and childhood conditions are not the focus of the study.

CONCEPTUAL FRAMEWORKS

Chronic disease is a public health as well as a clinical problem. Therefore, a population health perspective for developing strategies, interventions, and policies to combat it is critical. A population perspective considers how individuals’ genes, biology, and behaviors interact with the social, cultural, and physical environment around them to influence health outcomes for the



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