Background of Chronic Health Condition Care

Chronic diseases are diseases of persisting for a long time and generally slow progression A chronic disease is one lasting 3 months or more, by the definition of the U.S. National Center for Health. According to the Centers for Disease Control and Prevention (CDC), chronic diseases are responsible for seven out of every 10 deaths in the United States — taking the lives of more than 1.7 million Americans every year. Chronic diseases are also the primary driver of health care costs, accounting for more than 75 percent of the more than $2 trillion dollars spent each year on health care in the United States [1]. Today, Americans suffering from chronic diseases face rising healthcare costs. They also receive lower quality care and have fewer options. About 25% of people with chronic diseases have some type of activity limitation. This includes difficulty or needing help with personal tasks such as dressing or bathing. It may also mean being restricted from work or attending school. The disabling and long-term symptoms that often come with chronic diseases add to extended pain and suffering. This decreases the overall quality of life [2]. For example: Heart disease and stroke are the first and third leading causes of death, accounting for more than 30% of all U.S. deaths each year. Cancer, the second leading cause of death, claims more than half a million lives each year. Diabetes is the leading cause of kidney failure, non-traumatic lower extremity amputations, and new cases of blindness each year among U.S. adults aged 20–74 years. Arthritis, the most common cause of disability, limits activity for 19 million U.S. adults.  Obesity has become a major health concern for people of all ages. 1 in every 3 adults and nearly 1 in every 5 young people aged 6–19 are obese [3].

Current Paradigms for the Treatment of Chronic Illnesses

Our current paradigm for the management of chronic disease is malaligned. The medications we use are helpful for many patients with chronic disorders, but they are not curative and leave many individuals with unwanted adverse effects that are often treated with additional medication. The more effective approach to managing many patients with chronic diseases induced through unhealthy lifestyles would be to eat properly, exercise to maintain ideal body weight, and abstain from harmful substances. Managing the root causes of chronic disease would eliminate most of the unhealthy consequences and perhaps reduce the need for long-term medication [4].



Genetics and Health

In the genetics view, the physical appearance or a person’s health status is not only based upon the genetic information, but is also affected and modified by many internal and external conditions. It has often been conceptualized by the following relationship:

genotype (G) + environment (E) → phenotype (P)

or a more nuanced version of the relationship is:

genotype (G) + environment (E) + genotype & environment interactions (GE) → phenotype (P).  

Our health and illness, all are the results or outcomes from the interactions between our genes and our living environment including diet, exercise, lifestyle, living and working conditions etc. The body can be viewed as a personal garden, and the genes in the DNA can be viewed as different seeds of flowers, plants, trees, vegetables, weeds, etc.  Different seeds need different types of soil and specific conditions in order to grow and develop.  Similarly, in the body, different genes need different internal condition in order to express themselves.  Thus, our behavior and lifestyle changes can greatly affect and influence the expression of our genes in the body. Unhealthy behavior or unhealthy lifestyles or habits can trigger and activate unhealthy genes and turn the unhealthy genes on.  In the contrast, healthy behavior and lifestyle not only promote the expression of the healthy genes but also avoid or prevent the expression of the unhealthy genes. For example, Unhealthy diets and physical inactivity are two of the main risk factors for both obesity and T2DM. Previous studies have concluded that it is possible to prevent or delay T2DM in adults who are at risk for this disease through lifestyle changes in diet, exercise and weight loss [5, 6].

Epigenetics and Health

Epigenetics is the new paradigm on the horizon for basic and translational research for complex diseases. Epigenetic factors refer to reversible, heritable changes in gene regulation that occur without a change in DNA sequences [7]. Our genome contains all the information to make the physical appearance, but many of the details of our behavior and health status are actually determined by gene management.  Epigenetics means what we eat, how we live and love, alters how our genes behave [8].



  1. Health Care Reform and Chronic Disease: http://www.prnewswire.com/news-releases/health-care-reform-and-chronic-disease-62106472.html
  2. The impact of chronic diseases on health care: http://www.forahealthieramerica.com/ds/impact-of-chronic-disease.html
  3. Key Chronic Diseases: The Facts http://www.cdc.gov/chronicdisease/resources/publications/AAG/chronic.htm.
  4. Smith RE, Olin BR, Madsen JW. Spitting into the wind: the irony of treating chronic disease. J Am Pharm Assoc (2003). 2006 May-Jun;46(3):397-400.
  5. Steyn NPMann JBennett PHTemple NZimmet PTuomilehto JLindstrom JLouheranta A. Diet, nutrition and the prevention of Type 2 diabetes. Public Health Nutr. 2004. 7(1A):147-65.
  6. Hunking P. Lifestyle advice in preventing and treating Type 2 diabetes. J Fam Health Care. 2006;16(4):109-12.
  7. Epigenomics Study for Osteoporosis http://tulane.edu/publichealth/bio/biocenterhshen.cfm
  8. Epigenetics http://www.dukehealth.org/health_library/news/9322