How many times do we have to hear that our lifestyle choices impact our health outcomes?

In 2008, we asked a sample of Arizona adults (over 18) if they had been diagnosed with chronic conditions such as asthma, diabetes, heart disease, high blood pressure, arthritis or other auto-immune disorders. These questions were part of the Arizona Health Survey.

We also asked about anxiety disorder, depression or bi-polar (manic-depressive) disorder.

After correlating the answers to these questions with other data, we found that

• Over half of all adults (58%) have been diagnosed with one or more chronic conditions, and 14% have been diagnosed with three or more conditions. Chronic conditions affect over 2.7 million adults in Arizona.
• Nine out of ten (89%) of Arizonans over the age of 80 have at least one chronic condition, and almost one third (31%) have three or more conditions.
• But even many people in their forties (55% of them) report having been diagnosed with at least one chronic condition, and 9% report three or more conditions.
• Fifty seems to be a magic age for being diagnosed with something that will need constant surveillance. Among Arizona adults between age 50 and 64, the prevalence of chronic disease reaches 71%, and the percentage of adults with three or more conditions doubles (20%). And it gets worse from there.
• Within the 65-79 age group, 85% of the population has at least one chronic disease, and 28% have been diagnosed with three or more conditions.
• Fully 72% of Arizonans with chronic conditions – almost 2 million people – are working-age adults.

The most common chronic condition is high blood pressure, which affects almost a million and a half  Arizonans — close to a third of the adult population. Over a quarter of us have arthritis or similar auto-immune disorders. Almost half a million, or one in ten, have been diagnosed with diabetes (10.6%), and one out of six has been diagnosed with asthma (14.8%), both of which increase sharply after age 50.

This seems obvious, but rates of heart disease, hypertension and arthritis are relatively lower in younger age groups, and are dramatically higher among middle-aged adults. However, while diabetes and asthma level off in older populations, the rates of heart disease, high blood pressure and arthritis continue to rise. These conditions are linked to diet and obesity, and become major causes of disability in middle age and older adults.

Psychological conditions are more prevalent in younger adults, and then rates level off. Younger and much older people are more likely to be diagnosed with anxiety disorder than those in the middle, who are more likely to be treated for depression.

Chronic conditions, physical and psychological, are a huge strain on the health care system. And many of them can be improved with proper diet, exercise, and lifestyle changes. So as we attempt to reform the American healthcare system, what lessons can we learn from Arizona’s health statistics?

• Medical treatment alone is insufficient to address the causes of many chronic diseases. Public policy must also encourage health promotion and disease prevention by focusing on the behavioral and environmental factors (e.g., poor nutrition, lack of exercise, poor air quality, high levels of stress) that contribute to chronic conditions in the first place.
• Successfully managing chronic conditions requires ongoing coordination and monitoring by both the patient and a provider team. Public policy should encourage experimentation with new forms of medical payment that cover team-based services, and not just fee-for-service medical interventions alone, a concept called medical home.
• Many affective chronic conditions are diagnosed and treated in a primary care setting. Public policy should encourage the integration of physical and behavioral health in training programs and practice settings.
• Many chronic conditions may have a physiological and genetic basis, but poor lifestyle choices often contribute to the prevalence and severity of chronic conditions. Public policy should promote public education and advocacy to provide people with the knowledge, tools and incentives to keep themselves as healthy as possible.