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The Four Domains of chronic disease prevention : working toward healthy people in healthy communities
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    Modern efforts to prevent disease, help people lead healthier lives, and end health disparities must include a focus on chronic diseases.

    Chronic diseases—heart disease and stroke, diabetes, cancer, chronic lung diseases, and others—account for most deaths in the United States and globally.

    Chronic diseases and conditions are the major drivers of sickness, disability, and health care costs in the nation.

    Just as most chronic diseases are caused or made worse by many of the same risk factors, they can be prevented or lessened by many of the

    same strategies and interventions. The risk factors for chronic disease

    can and must be addressed at two levels: the individual level (including health care interventions) and the population level (including policies and environments that promote health). Working at both levels is essential.

    To optimize public health’s efficiency and effectiveness, the Centers for Disease Control and Prevention (CDC) recommends coordinating chronic disease prevention efforts in four key domains:

    1. Epidemiology and surveillance—to monitor trends and track progress.

    2. Environmental approaches—to promote health and support healthy


    3. Health care system interventions—to improve the effective delivery and

    use of clinical and other high-value preventive services.

    4. Community programs linked to clinical services—to improve and

    sustain management of chronic conditions.

    The four domains help organize and focus the effective work the public health community has been doing for many years. At the same time, they help concentrate efforts to strengthen programs and build expertise to address gaps in services. Finally, they help government agencies, state and local grantees, and diverse public and private partners find new ways to work together and support each other’s efforts.


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