Running Head: ABATEMENT OF CHRONIC DISEASE THROUGH IMPROVED NUTRITION POLICY

Abatement of Chronic Disease Through Improved Nutrition Policy

Delaware Technical Community College

NUR 420 Nursing Policy

Andrea DiMartino, RN
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Chronic Care Policy Action Plan

Chronic diseases are health conditions that last a year or more and require ongoing

medical attention or limits the activities of daily living. According to the Centers for Disease

Control and Prevention these diseases are also the leading causes of disability and mortality in

the United States. Additionally, chronic conditions impact the lives of six out of ten Americans,

and four in ten Americans suffer from two or more chronic conditions (National Center for

Chronic Disease Prevention and Health Promotion, 2019). Some examples of chronic diseases

include heart disease, hypertension, stroke, diabetes, obesity, cancer, chronic lung diseases, and

chronic kidney diseases. In the past 10 years our nation has seen major strides toward improving

health and reducing healthcare costs through the healthcare reform that was set in motion by the

Affordable Care Act (Adepoju, Preston, & Gonzales, 2015). It has done this by reducing

disparities in health and medical care by promoting access to equitable and more efficient health

coverage and ending the coverage discrimination for individuals with pre-existing conditions,

many of which are categorized as chronic illnesses (Nicole Rapfogel, 2020).

Identifying the Problem

For many chronic diseases, there are modifiable risk factors which include tobacco use or

exposure, excessive alcohol consumption, insufficient physical activity, and poor nutrition. With

an annual expenditure of nearly 3.5 trillion dollars, the largest portion of our nation’s healthcare

costs could be significantly reduced through more proactive preventative medicine through

programs that reduce incidences of these modifiable factors (National Center for Chronic

Disease Prevention and Health Promotion, 2019). While several risk factors are addressed within

the Affordable Care Act, such as smoking cessation or drug and alcohol counseling, the

disparities caused by food insecurity and lack of balanced diet account for the largest proportion
Abatement of Chronic Disease Through Improved Nutrition Policy 3

of health risks to Americans, yet nutrition is not a large proportion of reform addressed within

the legislature (Sav et al., 2015). Research published by the U.S. Department of Agriculture’s

Economic Research Service has supported that by reducing food insecurity for adults through

programs such as the Supplemental Nutrition Assistance Program (SNAP) those individuals are

less likely to develop chronic conditions. Furthermore, those receiving SNAP benefits that are

living with a chronic illness are more likely to adhere to prescribed medications to manage

existing conditions without the added financial burden of trying to maintain a sufficient and

healthful diet (Carlson & Keith-Jennings, 2018).

Goal of the Action Plan

The goal of this action plan is to reduce healthcare costs associated with the treatment of

chronic illnesses by investing further in preventative measures and proactive intervention. These

measures would include education and improved access to healthful diet choices in an effort to

reduce incidences of chronic illness in the United States as an expansion of the Affordable Care

Act. These improvements would be addressed through two initiatives, the reintroduction of

nutritional and food preparation education programs in public schools and the expansion of the

Supplemental Nutrition Assistance Program to include individuals identified as being at risk of

chronic conditions.

Finding Support in Legislature

Throughout the State of Delaware there are several legislators that have shown they are

open to progressive thinking and evidence-based models for improving health care. On the state

level, Bethany Hall-Long became Lieutenant Governor following a successful career in nursing

and is passionate about improving health policy for the state. With her background, she would
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likely prove to be a strong ally in enacting reforms surrounding chronic care, and her experience

and local connections improve the potential outcomes for pushing through legislature on a state

level. Beyond state support, bringing policy change to a national level would be accomplished

through support of our State’s Senators, Tom Carper and Chris Coons, and House Representative

Lisa Blunt-Rochester. In the past, all three of these individuals have shown their support for

healthcare reform through their voting record as well as the committees they are aligned with in

the House and Senate.

Currently in the State of Delaware there are several pieces of legislature being reviewed

concerning healthcare management and finance. Of note, House Bill 263 which limits out-of-

pocket cost of insulin for state employees and House Bill 286 which requires inadvertent out-of-

network costs be covered by health insurance (Delaware General Assembly, 2020). Though they

only chip away at the larger issues of cost associated with healthcare and the treatment of chronic

conditions, they show momentum toward equitable health coverage.

Key Talking Points

Proper nutrition is one of the most basic modifiable risk factors, yet it is not currently

addressed in the nation’s health plan in the same ways as smoking and alcohol counseling. Most

chronic conditions including heart disease, diabetes, some cancers, and obesity are directly

related to poor diet. Diets high in sodium and saturated fats while low in fruits and vegetables are

noted to be of the highest risk for chronic diseases (National Center for Chronic Disease

Prevention and Health Promotion, 2019). By getting in front of the issue through improved diet,

there will be a direct result of reduced incidences of certain conditions.

Acute care treatment costs significantly more than ongoing preventative care, especially

factoring in the cost of inpatient hospitalization. Improving patient outcomes, through patient
Abatement of Chronic Disease Through Improved Nutrition Policy 5

education and a team-based care approach by medical professionals with higher expertise and

skill, makes managing chronic conditions becomes more effective and cost efficient (Wagner et

al., 2001). Proactively identifying and educating individuals on modification of lifestyle and diet,

with support from a health team, has the potential to significantly reduce incidences of chronic

disease. Additionally, monitoring and managing care of patients with chronic conditions by a

healthcare team allows for rapid identification of increased risk. This allows more ardent

adjustments to care plans and reduces the need for emergency treatment of those conditions.

Reducing out-of-pocket healthcare costs helps to further taper incidents of hospitalization

or emergency care. An example of this is the practice of medication underuse by individuals with

low income. In order to afford to manage their chronic conditions, individuals skip or ration

doses of their necessary medications to help it to last longer. Though these tactics work in the

short term, they will often lead to higher treatment costs when the condition is worsened or an

acute consequence of insufficient symptom management results in emergency care or

hospitalization, both of which represent a much higher treatment cost. Because many incidents of

medication underuse have a direct connection with food insecurity, expansion of the

Supplemental Nutrition Assistance Program can be directly linked to lower healthcare costs and

a higher incidence of medication adherence (Carlson & Keith-Jennings, 2018).

Expansion of education surrounding nutrition and food preparation can reduce the

nation’s dependence on pre-packaged and processed foods. Since many packaged foods rely on

preservatives for longer shelf life, these foods are often a source of excess sodium. Additionally,

saturated fats and added sugars enhance the flavor of shelf-stable foods but decrease the

nutritional benefits of these offerings. By recentering nutrition interventions on younger

Americans, there is a greater opportunity to establish healthier habits and a greater sense of self-
Abatement of Chronic Disease Through Improved Nutrition Policy 6

reliance for teens and young adults. This recentering can be accomplished by working with the

Board of Education to reintroduce cooking and nutrition courses, formerly known as Home

Economics, to teach the basics of food preparation to the next generation (Thomas, 2016).

Setting things in Motion

Catching the attention of the legislature in order to effect real change, often through a

grassroots movement or social media blast, is the most assured way to garner support. With the

popularity of social media, and the presence of government officials on several platforms

including Twitter and Facebook, the support of constituents in several districts discussing a need

for change is a powerful step toward getting in front of the politicians that would eventually be

responsible for drafting legislation. The presence of nurses on these platforms give additional

credit toward being heard. Letter writing campaigns, video testimonials, and townhall meetings

are just a few ways that nurses can rapidly make their presence and opinions known to

lawmakers (Mason, et al., 2016). Direct contact with local and state lawmakers through email or

by arranging meetings are other ways to get a foot in the door and ensure the facts are getting to

the right people.

Conclusion

Through access to healthy foods and improved self-sufficiency, these policies have the

potential to save Americans trillions of dollars by reducing incidences of chronic illness. The

legislation put in place through the Affordable Care Act was a solid first step, but the model

focuses on illness treatment rather than health promotion. Instead, Americans need to be

empowered to see that an investment in the future health of the nation has the capacity for

massive reform and cost savings while improving the quality of life for millions of Americans.
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References

Adepoju, O., Preston, M., & Gonzales, G. (2015, November). Health Care Disparities in the

Post-Affordable Care Act Era. Retrieved October 05, 2020, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4627524/

Carlson, S., & Keith-Jennings, B. (2018, April 05). SNAP Is Linked with Improved Nutritional

Outcomes and Lower Health Care Costs. Retrieved October 05, 2020, from

https://www.cbpp.org/research/food-assistance/snap-is-linked-with-improved-nutritional-

outcomes-and-lower-health-care

Coleman, K., Austin, B., Brach, C., & Wagner, E. (2009). Evidence on the Chronic Care Model

in the new millennium. Retrieved October 11, 2020, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5091929/

Delaware General Assembly. (2020). Delaware Legislation. Retrieved October 11, 2020, from

https://legis.delaware.gov/AllLegislation

Mason, D. J., & Gardner, D. B. (2016). Policy & politics in nursing and health care (7th ed.). St.

Louis, MO, MO: Elsevier.

National Center for Chronic Disease Prevention and Health Promotion. (2019, October 23).

About Chronic Diseases. Retrieved October 05, 2020, from

https://www.cdc.gov/chronicdisease/about/index.htm

Nicole Rapfogel, E. (2020, March 23). 10 Ways the ACA Has Improved Health Care in the Past

Decade. Retrieved October 05, 2020, from

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https://www.americanprogress.org/issues/healthcare/news/2020/03/23/482012/10-ways-

aca-improved-health-care-past-decade/

Sav, A., King, M., Whitty, J., Kendall, E., McMillan, S., Kelly, F., . . . Wheeler, A. (2015, June).

Burden of treatment for chronic illness: A concept analysis and review of the literature.

Retrieved October 05, 2020, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5060781/

Thomas, L. (2016, October 14). Public supports bringing back home ec cooking lessons for the

health of it. Retrieved October 11, 2020, from https://news.umich.edu/public-supports-

bringing-back-home-ec-cooking-lessons-for-the-health-of-it/

Wagner, E., Stuart, B., Adler-Milstein, J., Bishop, T., Lamb, G., Koh, H., . . . Gillies, R. (2001).

Improving Chronic Illness Care: Translating Evidence Into Action. Retrieved October 05,

2020, from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.20.6.64