TWELVE LEADING PUBLIC HEALTH CONCERNS

Although they don’t receive as much attention as rising healthcare premiums or drug breakthroughs tend to, public health concerns that affect communities at large are among the biggest challenges on the nation’s healthcare landscape.

Public health professionals in the United States are working to remedy and prevent these 12 important health concerns:

1. OBESITY

‘Overweight’ and ‘obese’ are terms which the World Health Organization (WHO) defines as “abnormal or excessive fat accumulation that presents a risk to health.”¹ The Centers for Disease Control and Prevention (CDC) notes that Body Mass Index (BMI) is a screening tool used to identify these conditions: It’s found by dividing a person’s weight in kilograms by the square of height in meters. With a BMI of 25-29.9, a patient is called overweight, while a BMI of 30 or more qualifies that person as obese.²

Obesity is linked to significantly increased risk of chronic health conditions, including type 2 diabetes, heart disease, high blood pressure, and cancer. In 2017-2018, according to the Centers for Disease Control and Prevention (CDC), more than 42 percent of adults in the U.S. were obese.³

Obesity also has a high economic cost. According to the most recent numbers available, we spent an estimated $315 billion treating obesity in 2010 ($147 billion in direct medical costs and $168 billion in costs related to lost productivity, premature death, and disability).⁴

The rate of obesity has leveled off in recent years, but at 40 percent of adults, it’s still very high. Perhaps even more concerning, it affects 17 percent of youth and teens, and can lead to serious health consequences later in life.⁵ The U.S. is the only wealthy country to experience a decline in life expectancy, likely as a result of chronic conditions such obesity.⁶

2. HYPERTENSION

Hypertension, commonly known as high blood pressure, affects 45 percent of adults in the U.S. and can lead to medical emergencies such as heart attack and stroke.⁷ It is often labeled as ‘the silent killer’ because there aren’t any early symptoms of the disease.⁸

Hypertension puts pressure on blood vessels as they pump blood throughout the body. It can occur as a result of genetics, unhealthy diet, and lack of physical activity. Other health conditions, such as obesity and diabetes, can also increase a person’s risk of developing high blood pressure, while eating a healthy diet and exercising regularly can help lower blood pressure.⁹

3. HEART DISEASE AND STROKE

Heart disease is the leading cause of death for men and women across almost every racial and ethnic group in this country, killing more than 647,000 Americans each year. The financial costs of heart disease are estimated at $219 billion a year for medications, treatment, and lost productivity due to premature death.¹⁰ People with coronary heart disease are also at higher risk of a heart attack or stroke.¹¹

4. TYPE 2 DIABETES

Type 2 diabetes is a chronic condition that affects how the human body processes glucose (blood sugar). In 2018, an estimated 34.2 million Americans—10.5 percent of the total population—had type 2 diabetes. The previous year, the disease was responsible for $237 billion in direct medical costs and $90 billion in reduced productivity.¹²

Another 88 million Americans have pre-diabetes,¹³ which can lead to diabetes if no lifestyle changes or other interventions are put into effect. Even after adjusting for differences in age and sex, healthcare costs for someone with diabetes are 2.3 times higher than for someone without it.¹⁴

5. DEPRESSION AND ANXIETY

Mental health is a significant public health issue, and resources to address it are limited in almost every community nationwide. Around 40 million adults experience anxiety, making it the country’s most prevalent mental health disorder. Major Depressive Disorder (MDD) affects 16 million adults, and many experience MDD and anxiety.¹⁵ The costs of poor mental health are hard to quantify, but studies have shown that it can have adverse effects on ‘critical development transitions,’ including marriage, educational attainment, childbearing, and the ability to get and maintain employment. This can have far-reaching consequences in terms of financial security, social support, and other health indicators.¹⁶

6. PRESCRIPTION DRUG ABUSE

In the United States between 1999 and 2019, the number of overdose deaths involving prescription opioids and heroin quadrupled. Starting in 2010, heroin overdose deaths increased, and deaths from synthetic opioids began surging in 2013. Public health officials believe that prescription drug abuse in the 1990s led to recent, increased abuse of illegal drugs, and deaths related to heroin and synthetic opioids.¹⁷ The opioid crisis was declared a public health emergency in 2017, a year in which opioids caused almost seven in 10 overdose deaths nationwide.¹⁸ Legislative and public health initiatives to curb opioid abuse include prescription drug monitoring programs to help doctors track opioid prescriptions for each patient, and increased access to substance abuse treatment programs.¹⁹

7. ALCOHOL AND TOBACCO USE

Tobacco use in any form is linked to chronic health conditions such as heart disease, stroke and cancer, and can lead to premature death. After decades of decline in the U.S., it’s once again on the rise after the commercial introduction of e-cigarettes. In an alarming trend, teen e-cigarette usage almost doubled from 2017 to 2018, increasing from 11.7 percent to 20.8 percent in just a year.²⁰

Excessive alcohol consumption also has significant health consequences, negatively affecting the brain, heart, liver, and pancreas. Chronic liver disease and cirrhosis from alcohol use affect approximately 4.5 million people in the U.S. and is the cause of 41,783 deaths each year.²¹ Alcohol use is a risk factor for multiple cancers, including head and neck cancer, breast cancer, colorectal cancer, and liver cancer.²²

8. DISTRACTED DRIVING

Motor vehicle accidents have long been a source of premature death and a recurring public health concern. An increase in vehicle safety features, such as seatbelts and airbags, has reduced injuries and fatalities, but distracted driving—especially during smartphone use—continues to be a significant problem, contributing to 2,841 fatalities in 2018.²³ Many states have enacted strict laws to punish distracted drivers and reduce the harm they often cause: 22 states, the District of Columbia, and all four U.S. territories ban handheld cellphone use, 37 states ban cellphone use for novice drivers, and 48 states ban texting while driving.²⁴

9. FOOD SAFETY

Foodborne illness affects millions of people every year, resulting in over 128,000 hospitalizations and 3,000 deaths. It can be the result of unsanitary or unsafe production practices on large farms and food processing facilities, or lack of education and poor food handling procedures in the kitchen.²⁵ As the food supply in the U.S. increasingly comes from large farms and production facilities that ship around the country, foodborne illness is likely to remain a problem.

10. ANTIBIOTIC RESISTANCE

Every year, 2.8 million people in the U.S. contract an antibiotic-resistant infection. Fighting this public health challenge requires a concerted effort by infectious disease experts, medical professionals, and patients to limit unnecessary use of antibiotics.²⁶ Overprescribing antibiotics or using them in situations where they do not help (to treat viruses, for example) allows microbes to adapt and strengthen, limiting an effective anti-infection tool.

11. AIR POLLUTION

Air pollutants present a significant and growing health hazard. Emissions from vehicles and the burning of fossil fuels, combined with a warming climate, make the air we breathe dangerously polluted. Microscopic pollutants slip through our body’s natural defenses into the lungs, heart, and brain.²⁷ While air pollution can affect anyone, it takes a larger toll on low-income communities, where people are more likely to live near pollution sources, have less access to healthcare, and live at higher risk of developing other chronic health conditions, such as asthma or heart disease, which are exacerbated by air pollution.²⁸

12. SPREAD OF COMMUNICABLE DISEASES

Efforts to curb communicable disease date back at least to the 1600s, when European cities appointed public health officials to enforce quarantine measures during The Plague.²⁹ While many relate the term “pandemic” to COVID-19, a pandemic is defined by the World Health Organization (WHO) as “an epidemic occurring worldwide … crossing international boundaries and usually affecting a large number of people.”³⁰ COVID-19 is the biggest pandemic outbreak in over 100 years, but every year, public health professionals fight against communicable disease pandemics such as influenza, which results in hundreds of thousands of deaths worldwide, as well as other smaller outbreaks that don't reach pandemic status.³¹ The American Public Health Association's Control of Communicable Diseases Manual lists more than 200 diseases, including malaria, Zika, and Ebola. Public health officials work to prevent their spread by promoting sanitation and vaccination.³²

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