The Definition of a Chronic Disease – What Does It Really Mean?  
 
According to leading health experts in the United States, nearly one in two Americans (or 133 million people) has a chronic medical condition of one kind or another[1]. One in two. So what does it really mean to those living with a chronic medical condition and are some conditions “more chronic” than others?  At the age of 21, I was seen by a physician and told I suffered from “chronic arthritis.” I really can’t remember a time in my life (I’m now 60) that I ever thought of myself as either suffering from a chronic disease or even being down for the count as a result of arthritis. Sure, once in a while I suffer from various aches and pains, but who doesn’t? But for many who are living with arthritis as a chronic disease, it is life-changing and for some life-altering to the point where every day tasks I take for granted are unattainable for them.  For those, yes, it is a chronic condition. 
 
But by identifying half of the population as living with a chronic medical condition, do we unknowingly diminish the challenges that some of the more severe conditions or more severe stages of a condition create? Is my chronic diagnosis the same as that of a child with juvenile diabetes? Certainly not. That child’s life is profoundly different as is the experience of their entire family. How is a family affected by chronic asthma the same or different than a family affected by chronic emphysema? 
 
Would it help if we created tiers or degrees of chronic-ness? The reason I ask this question is that on a daily basis I face an ever-increasing number of young people who are now living with the chronic disease of HIV. Certainly HIV as a chronic disease has some distinct hallmarks in that it is a communicable disease and still carries with it stigma that say a person with rheumatoid arthritis may not often face. But by labeling HIV as a chronic condition do we unknowingly send a message that it isn’t that bad? Was the prevention of HIV easier when it was labeled a fatal condition? Could we cut down the number of adult-onset diabetes diagnoses if we referred to morbid obesity in young people as a fatal condition? 
 
We all want to provide reassurance and certainly hope for those living with ongoing medical problems. But when everyone has the same label, how do we simultaneously offer hope to those with quite serious diseases while realistically portraying what lies ahead. For someone living with HIV in 2010, they can anticipate a lifetime of high medical expenses including skyrocketing pharmaceutical costs along with a lifetime of lab tests. And they will live with never knowing when these medications might stop working or actually bring on other medical concerns such as liver or heart problems. 
 
Perhaps we would all be better served and the health care debate moved along by understanding that the words “chronic medical condition” need to be more fully thought through. Figuring out how we manage treatment costs for 50 percent of the population living with chronic conditions or illness is really a significant factor in this health care debate.     
 
As us baby boomers age and more and more are diagnosed with a chronic condition, we need to focus our attention on both evidence-based best practices for treating these conditions as well as on disease prevention. While perhaps at opposite ends of the spectrum, by only doing one without the other, we will continue to break the health care system and all but a few will ultimately fall through the widening cracks.
 
 


[1] Chronic Care in America: A 21st Century Challenge, a study of the Robert Wood Johnson Foundation & Partnership for Solutions: Johns Hopkins University, Baltimore, MD for the Robert Wood Johnson Foundation (September 2004 Update). "Chronic Conditions: Making the Case for Ongoing Care".