Scanning the chronic disease terrain: prospects and opportunities

The disease burden in the United States has changed radically in the past 100 years. A striking decrease in infectious diseases as causes of morbidity and mortality has been followed by a steady increase in morbidity and mortality rates from chronic disease, which is now the dominant health issue facing the country, at levels justifying considering chronic disease as having reached epidemic proportions. Research in recent years has shown that many of the common chronic diseases are malleable, i.e., susceptible to therapeutic or preventive efforts aimed at risk factors and susceptible age eras and populations. Although clinical and population-oriented interventions have been increasingly successful in recent decades, more intensive and coordinated preventive efforts will be required, including effective partnerships between clinical medicine and other sectors, particularly at-risk individuals, government, and public health. Robust joint efforts are not only needed, but are likely to be successful.