“That is the amount of time it would take to see results in terms of prevention mitigation and changing people’s lifestyles,” says Kevin Klowden, managing economist at the Santa Monica, California-based nonprofit and an author of the report released this month.

The institute said American businesses lose $1.1 trillion annually in productivity because of chronic illness.

At the heart of the problem is obesity, which leads to high blood pressure, heart disease and diabetes and exacerbates problems associated with other diseases. Klowden says that to cut costs, the prevalence rate of obesity would have to be trimmed to 1998 levels, when 19 percent of the population was obese, compared with 22.8 percent in 2003 and an estimated 25.3 percent today. Obesity would have to be treated as a national epidemic similar to smoking.

“Skyrocketing obesity levels may portend an epidemic of chronic diseases and related treatment costs that threaten to overwhelm the public and private sectors,” the report states.

Ken Thorpe, a professor of public health at Emory University, says the Milken Institute’s estimate of the impact of chronic disease is conservative. To reduce costs, employers must use a combination of programs and incentives to detect health problems early and change benefit structures so people who need medications to stay healthy get them at no cost. He says getting treatments to workers at the work site is the most effective way to improve people’s health.

“Without going after the underpinning of health care costs—obesity and the explosion of chronic illness—we won’t be able to reduce health care costs,” Thorpe says.

Even if those measures were implemented immediately on a national level, it would take several years before the escalating costs could be reversed. Without changes, however, the economic impact of chronic diseases will reach $6 trillion by midcentury, according to the report.

Hypertension is the most common chronic disease in the workforce, as 27.2 million employed Americans reported missing at least one day of work in the past 12 months as a result of having the condition. Asthma was second highest with 13.8 million and heart disease third with 9.5 million workers missing work.

In terms of indirect economic costs, including lost workdays and lost productivity at work, hypertension alone cost $123.6 billion in 2003, the last date for which data was available. The indirect cost of all cancers was $120.4 billion, which includes lost productivity of workers who are the primary caregivers for those with an illness. Mental health problems cost employers $75.9 billion in indirect costs.

The most effective disease management programs help patients coordinate their care with a family member and their doctor rather than rely on third-party help lines and health coaches, says Mike Thompson, a principal at PricewaterhouseCoopers.

“People listen to their spouse and their doctor; they don’t listen to third parties,” he says.

West Virginia, Tennessee and Arkansas had the highest prevalence of chronic illness. The impact of chronic disease varied throughout the country but could be linked to two key factors: smoking and poor diet, Klowden says. The state with the lowest rate of chronic disease was Utah.

—Jeremy Smerd