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Choosing to Make America Healthier
San Diego Union-Tribune
June 13, 2008
By Michael Milken

San Diego's thousands of biotechnology researchers work in a field of mind-boggling complexity that requires years of rigorous training. They can tell you how hard it is to make even small advances against major diseases.

So assuming you don't have an advanced scientific degree, you might think there's nothing you can do to achieve the kind of medical breakthroughs that would eliminate half the diabetes cases, prevent one of every five cancer deaths, and save trillions of dollars. Anyone who developed a pill that could do that would win a Nobel Prize.

You have that pill. It's called lifestyle choice. And it's free.

The fact that lifestyle affects health isn't news. But in a recent report, the Milken Institute showed lifestyle's economic impact – how our choices contribute to chronic diseases that increase treatment and insurance costs, reduce productivity, erode our international competitiveness and, worst of all, magnify personal suffering.

The report, “An Unhealthy America: The Economic Burden of Chronic Disease,” quantifies the staggering costs of “failing to contain the containable.” In this presidential election year, we need more focus on these costs, which undermine prospects for extending health insurance coverage and for coping with the medical burden of an aging population. The opportunity costs also include diversion of skilled research and clinical talent to chronic-disease care.

For every dollar we spend on treatment, we lose three to four times as much indirectly. When chronically ill workers take sick days, their absenteeism reduces the supply of labor and with it the gross domestic product. But the greatest GDP impact is from “presenteeism,” which reduces output when sick employees show up for work to avoid losing wages and then perform below par. Combining the diversion of caregivers with the costs of absenteeism and presenteeism, the total impact of chronic disease already exceeds $1 trillion a year, including more than $100 billion in California alone.

This cost is one of three interdependent health policy concerns. The second is the cost of advanced research. Third is the system of distributing and paying for medical services so all Americans have access to high-quality care. If we address all three with good policy decisions, we can assure longer life spans and higher quality of life at substantially reduced cost.

But we need to start now. By mid-century, the preventable impact of seven chronic diseases – diabetes, pulmonary conditions, hypertension, mental disorders, heart disease, cancers and stroke – could reduce annual GDP by six trillion dollars a year.

Behavioral choices – especially those that underlie obesity – often affect the prevalence, severity and costs of these diseases. While genetic factors are very important, as much as 70 percent of direct health care spending is to treat lifestyle-related conditions. In calculating cost savings, our report assumed only a modest reduction in the percentage of overweight and obese Americans from the current two-thirds to about half.

We can and should do better. One of every four Americans is now more than 20 percent above ideal body weight, the dividing line between overweight and obese. That's up from one in eight as recently as 1990. What if we turned the clock back only a decade, returning to 1998 obesity levels? The impact would be 15 million fewer cases of the seven chronic diseases by 2023. In that year alone, without adjusting for inflation, we would reduce health care spending by $60 billion and increase productivity by $254 billion. In fact, the single most effective way to reduce the burden of disease and lower costs is to reduce obesity.

No one claims it's easy to change diet and exercise habits. In my case, it took a doctor saying, “You have cancer.” Yet we've made progress against smoking – another entrenched habit – and I believe we can do the same with obesity.

It's also vital that we build on our national commitment to medical research. If we continue cutting back on research, we risk losing a generation of young physician-scientists. Unfortunately, recent National Institutes of Health budgets have declined in real terms. That trend has a large impact on San Diego because of this area's many life-sciences laboratories. Yet with better cooperation among industry, academic and government researchers, we can still make real progress toward life-saving cures. If that means eliminating some bureaucratic regulations that limit joint public-private efforts, let's do it.

America woke up 50 years ago when Sputnik shocked us into action. We need similar resolve today so chronic diseases don't undermine our economy from within the way the Soviet challenge of the 1950s threatened our security from without. Each of us can help by taking reasonable steps to reduce our personal chronic-disease risks. Progress against the preventable cost of these diseases will free up the human, social and financial capital we need to fund crucial research and provide high-quality healthcare to all Americans.

Mr. Milken is chairman of the Milken Institute in Santa Monica.