June 8, 2004
Thank you, Mr. Chairman, Members of the Committee, for the opportunity to address an important health problem in our society - that of preventing, controlling and curing arthritis.
The National Arthritis Act of 1974 (Public Law 93-640) as enacted in 1975 has largely been successful in promoting basic and clinical arthritis research and establishing Multidisciplinary Clinical Research Centers. Arthritis is a large problem that is getting larger as our population ages. The public health efforts called for in the 1974 Act have only recently been initiated. The National Arthritis Action Plan: A Public Health Strategy was published in 1999. Our health priorities for the nation, Healthy People 2010, include arthritis objectives for the very first time.
In my remarks today, I would like to focus on the impact of arthritis in the United States and the opportunities public health has to make a difference in reducing the pain and the disability associated with arthritis. I would also like to highlight a few of our activities: an example from one of our state-funded arthritis programs; a research program examining the incidence and progression of arthritis; and, a health communications campaign designed to increase physical activity among persons with arthritis.
Impact of Arthritis: Today and in the Future
Arthritis comprises over 100 different diseases and conditions. The most common are osteoarthritis, gout, fibromyalgia, and rheumatoid arthritis. Common symptoms of arthritis include pain, aching, stiffness and swelling. Some forms of arthritis, such as rheumatoid arthritis and lupus, affect multiple organs, and associated with premature death.
In 2001, 49 million adults reported a doctor had told them they had arthritis; nearly one of every four adults--making it among the most common health problems in the United States. An additional 21 million Americans reported chronic joint symptoms that may be arthritis, but have yet to be told by a physician they have arthritis. In the next 25 years as the population ages, CDC estimates that 71 million adults will have arthritis, including a doubling of the rate among adults over age 65. This is likely a conservative number, since it does not take into account the ongoing obesity epidemic in America, which may significantly contribute to the future prevalence of arthritis.
Although rarely discussed, arthritis causes over nine thousand deaths each year. Most notable, is the fact that arthritis-related mortality disproportionately affects women and minorities. For example, systemic lupus deaths show marked age, sex, and race-specific disparities with the highest death rates occurring among working-age, black women.
Arthritis and its related disability cause an enormous burden for the people who have arthritis, their families and society. Arthritis is the most frequent cause of activity limitation in America; more than eight million citizens are limited in some way because of arthritis. Arthritis is also a significant cause of work disability, especially for persons with inflammatory arthritis, such as rheumatoid arthritis, of which, as many as 30 percent may be work disabled. Each year, 750,000 hospitalizations and 36 million outpatient medical care visits occur because of arthritis. Arthritis is costly to society and individuals. In 1997, arthritis cost more than $51 billion in direct medical costs and another $35 billion in indirect costs. No doubt, these numbers will increase dramatically as our population ages and the number of people with arthritis increases.
We know other things about people with arthritis. People with arthritis
The Role of Public Health in Arthritis
CDC has identified the following critical priorities to address arthritis:
Reducing arthritis-related disability will benefit our aging population in America. In seven years, the leading edge of the baby-boomers will reach age 65. Many older Americans, those most likely to have arthritis and to be limited by arthritis, may need to or wish to work longer. We will need to better understand how we can reduce arthritis-related disability and how older Americans can be accommodated in the workplace so that they can remain active and, if they choose to be, employed. This aging trend will have enormous implications for our society.
CDC and the public health community in our states and communities have a continued role to play in bringing the benefits of prevention to persons with arthritis. Public health brings the focus on population-based approaches to health, the knowledge of what works, and links to the clinical community. What CDC brings to the table is its well-recognized scientific expertise, long-standing experience in prevention research, the ability to evaluate health promotion programs and identify those that work, knowledge of the public health network and the ability to work with states and communities to implement disease prevention and health promotion programs, and unique surveillance capacity to better guide programmatic efforts.
Priority areas to address:
CDC works closely with the Arthritis Foundation, the voice for people with arthritis and their families for more than 50 years. The Arthritis Foundation recognizes the need for health promotion strategies for people with arthritis that are tested and proven effective. CDC's strength is its ability to demonstrate the effectiveness of an intervention strategy or program and help states and communities put it into practice.
The growing evidence for the benefits of healthy behaviors (physical activity and weight control) and disease management strategies for people with arthritis must be shared and implemented widely in public health practice. CDC can, through its leadership role in the public health community, make sure that the growing body of evidence that we can improve the quality of life among people with arthritis is applied through public health practice and supported by clinical medical practice.
Current CDC Efforts
Despite the enormous burden of arthritis, public health efforts for arthritis are fairly new. Prior to 1998, we are aware of only two states that had organized activities addressing arthritis: Missouri and Ohio. There was no national public health plan for arthritis and arthritis had never been made a priority in our national health objectives. CDC, too, had limited efforts.
The National Arthritis Action Plan: A Public Health Strategy was developed by CDC, the Association of State and Territorial Health Officials, and the Arthritis Foundation with the help and input of 90 other organizations to address this large and growing problem. This landmark plan recommends national, coordinated efforts to reduce pain and disability and improve the quality of life for people with arthritis. This plan forms the foundation for CDC's arthritis efforts.
The primary goal of the CDC Arthritis Program is to improve the quality of life for people affected by arthritis-decreasing the pain and disability that often accompany arthritis. Since 1999 when CDC received its first ever appropriation for arthritis, CDC has made progress.
Improve how we measure the burden of arthritis.
In conclusion, I would like to thank the Committee for its leadership and commitment to the health of our nation and the interest in people affected by arthritis. Great progress has been made in addressing arthritis, one of our most common chronic conditions. The nation has a national plan, catalyzing activities in both the public and private sectors. State programs, almost unheard of just six years ago exist in 36 states. The pain and disability of arthritis can be improved. We need to continue our work to identify promising approaches, develop new approaches, and put this science into action-getting programs that work out to the people who need them.
I would be happy to answer any questions from the Committee.
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Last Revised: June 8, 2004