Chronic diseases have replaced infectious diseases as one of the nation's greatest public health threats.1 Defined as diseases that last 3 or more months, an estimated 45% of all Americans are living with at least 1 chronic health condition2 and more than 75% of our nation's health care spending is associated with chronic disease.3 Chronic diseases also have a substantial impact on workforce economic issues such as productivity, wages, earrings, early retirement, turnover, and disability.4

Conditions traditionally considered as chronic include cardiovascular disease, diabetes, asthma, and coronary obstructive pulmonary disease. As disease survival rates and associated life expectancies have increased, new illness are now considered chronic such as many types of cancer, HIV/AIDS, mental disorders (depression, schizophrenia, and dementia), and disabilities (sight impairment and arthroses).4 These diseases have long latency periods, often have origins in younger ages, and require long systematic approaches to treatment. However, most chronic health conditions are largely preventable, thereby offering many opportunities for prevention. Chronic diseases have complex and interrelated "vectors"5 that are largely behavioral (eg, physical inactivity, obesity, poor nutrition, tobacco use, and excessive alcohol intake) and environmental (stress and early exposure to chemicals) in nature.6

The Centers for Disease Control and Prevention3 and the World Health Organization7 report that:

* chronic diseases affect nearly 1 in every 2 adults in the United States;

* chronic diseases were responsible for 36 million deaths in 2008;

* chronic diseases restrict daily limitations in a quarter of affected adults;

* 90% of chronic diseases occur in middle-to-low income countries;

* 50% of deaths occur among women; and

* chronic diseases are modifiable through behavioral interventions.

The fight against chronic disease is at a critical crossroad.3 Recommendations in a recent "call to action" issued by the Centers for Disease Control and Prevention include harnessing the collective capacity and energy of communities to improve well-being, policy programs, health equity, research translation, and workforce development.3 The articles of Family & Community Health address a wide range of chronic diseases, as well as behavioral risk factors and social determinants of health that underlie them. Type 2 diabetes mellitus (T2DM) has a considerable impact on patient health and the health care system in the United States; 3 of the 8 articles focus on this topic. Estrella et al present lessons learned from a diabetes disparities reduction plan implemented by the Centers for Medicare and Medicaid. The other 2 diabetes-related articles present results from a type 2 diabetes self-management program (Helduser et al) and a group-based diabetes prevention intervention targeting adults (Skelton et al), respectively. Pitts et al describe the process of engaging a community in the development of a multilevel intervention to address cardiovascular disease risks in a rural population. T2DM accounts for at least 90% of diabetes in the United States, and an additional 7.9 million individuals have prediabetes. Interventions designed to prevent and control, such as those presented, are critically needed in the effort to address the T2DM epidemic.

The other 4 articles included address HIV risk reduction (Brawner et al), sickle-cell anemia (Valenzuela et al), advocacy for pediatric health care (Wooldridge et al), and social determinants of hand-washing practices (Dobe et al). In 2009, an estimated 33 million people were living with HIV. Advances in the antiretroviral treatments have increased the life expectancy for people living with HIV, rendering this disease into a manageable chronic illness.4,8 Despite treatment advances, the prevention of HIV is critically important for controlling this epidemic. Brawner et al present early outcomes from an innovative HIV prevention feasibility study with heterosexual African American males in a community-based setting. Sickle-cell disease-an inherited disease predominately affecting African Americans-is known to be a painful and debilitating condition that requires frequent medical care and hospital admissions. Although no cure currently exists for sickle-cell anemia, treatment can improve the anemia and health behavior patterns (sufficient sleep, adequate fluid intake, stress reduction, and lack of tobacco use) can lower complications.9 Given the frequent painful "episodes" of this disease that often require hospitalization, dealing with this condition can be particularly challenging during adolescence-a developmental period with elevated concerns regarding peer acceptance and physical appearance. Valenzuela et al describe the outcomes of a qualitative study with youth using Photovoice as an outlet for sharing their experiences with sickle-cell anemia. Pediatric and adolescent patients can often benefit from the utilization of an advocate to ensure the delivery of quality treatment in health care settings. Wooldridge et al present a thought-provoking article that further explores the health advocacy within a medical home framework, a concept that was originated by the American Academy of Pediatrics in 1967. Finally, Dobe et al discuss the social determinants of good hand-washing practices among adolescents in a rural community in India. Hand-washing practices have been shown to be effective in reducing the spread of communicable diseases, as well as fitting well within a cascade of health-promoting behaviors.

Reducing the incidence and prevalence of chronic diseases worldwide requires long-term and coordinated responses from a myriad of partners including the health care community, policy makers, community-based organizations, and the general public. We sincerely hope that the articles in this special issue highlight the problems as well as the promise of accomplishing this goal.

-Bettina M. Beech, DrPH, MPH

Issue Editor

Rural Health and Health Disparities,

Family Medicine, University of Mississippi Medical Center,

Jackson, Mississippi

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