National Chronic Disease Strategy

Client:  Centers for Disease Control and Prevention (CDC) and National Heart, Lung, and Blood Institute (NHLBI)

Authors/Consultants: Homer J, Milstein B, Wile K, Trogdon J, Orenstein D, et al.

At least 70% of deaths among Americans each year are from chronic diseases, and their direct and indirect costs are more than 1 trillion dollars per year.  Governmental health agencies are in a position to promote strategies to prevent and manage chronic disease, but identifying the most effective and economical strategies is often difficult.  To help health agencies better plan and evaluate interventions, the CDC and the NHLBI funded the creation of the Prevention Impacts Simulation Model (PRISM).  PRISM is a relatively large system dynamics model that is used to simulate trajectories for health and cost outcomes for the entire U.S. population from 1990 to 2040, and has also been applied to represent other national and local populations.  Interventions are in several broad areas: medical care, smoking, nutrition and weight loss, physical activity, emotional distress, and particulate air pollution.  These interventions act through a range of channels such as access, price, promotion, and regulation.  The diseases and conditions modeled in detail include heart disease, stroke, diabetes, hypertension, high cholesterol, and obesity, and the model also accounts for cancers and respiratory diseases related to smoking, obesity, poor nutrition, and physical inactivity.  The model reports summary measures of mortality and years of life lost as well as the consequent medical and productivity costs of the chronic diseases and conditions modeled.  Local and federal health officials have used PRISM throughout its development, and its applications continue to grow in number and variety.


- Homer J, Milstein B, Wile K, Trogdon J, Huang P, Labarthe D, Orenstein D. (2010)  Simulating and Evaluating Local Interventions to Improve Cardiovascular HealthPreventing Chronic Disease 7(1).

- Homer J, Milstein B, Wile K, Pratibhu P, Farris R, Orenstein D. (2008) Modeling the Local Dynamics of Cardiovascular Health: Risk Factors, Context, and Capacity. Preventing Chronic Disease 5(2).

- Hirsch G, Homer J, Evans E, Zielinski A. (2010)  A System Dynamics Model for Planning Cardiovascular Disease InterventionsAmerican Journal of Public Health 100(4):616-622.

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