There is solid indisputable evidence that the contemporary traditional disease-oriented medical system is not serving society well:

* 7 out of 10 deaths among Americans each year are caused by chronic lifestyle-related diseases, primarily cardiovascular disease, diabetes and cancer [1]. By 2020, their contribution is expected to rise to 73% of all deaths globally [1, 2].

* Cardiovascular diseases remain the leading cause of morbidity and mortality in modern societies, followed by cancer [3, 4]. In 2009, cardiovascular diseases accounted for 32.3% of all deaths, or 1 of every 3 deaths in the United States [4]. The total number of inpatient cardiovascular operations and procedures increased 28% between 2000 and 2010.[4]

* 33% of US adults (78 million) over 20 years of age have high blood pressure [4]. Among these, almost 20 % aren’t aware of their condition [4]. High blood pressure is a major and most common risk factor for developing cardiovascular disease and mortality [5]. The mortality risk doubles for every 20-mmHg increase in systolic blood pressure above the threshold of 115mmHg and for every 10-mmHg increase above the diastolic blood pressure threshold of 75mmHg [6].

* In 2010, an estimated 19.7 million Americans had diagnosed diabetes, representing 8.3% of the adult population. An additional 8.2 million had undiagnosed diabetes, and 38.2% had pre-diabetes, with elevated fasting glucose levels [4]. The prevalence of diabetes is increasing dramatically, in parallel with the increases in prevalence of overweight and obesity.

* The United States spends significantly more on “sick” care than any other nation. In 2006, our medical expenditure was over $7,000 per person [7], more than twice the average of 29 other developed countries [8]. We also have one of the fastest growth rates in sick care spending, tripling our  expenditures since 1990 [7]. Yet the average life expectancy in the United States is far below many other nations that spend less on health care each year.

* An increasing percentage of health care dollars spent in the U.S. are spent on people with chronic conditions. In 2004, the care given to people with chronic conditions accounted for 85% of all of health care spending [9].

* The total direct and indirect cost of cardiovascular disease and stroke in the United States for 2009 was $312.6 billion. By comparison, in 2008, the estimated cost of all cancer and benign neoplasms was $228 billion. CVD costs the US sick care system more than any other diagnostic group [4].

* In treating patients with chronic conditions, 66% of physicians believe their mandatory medical training did not adequately prepare them to provide effective nutritional guidance for their patients.[10]

* The largest number of people with chronic conditions is of working age and is privately insured. Almost all Medicare dollars and about 80% of Medicaid spending is for people with chronic conditions [9].

The only solution to combat today’s major killers – cardiovascular disease, diabetes and cancer – is via health promotion and preventive medicine. [11, 12]

Dr. Citrin is a member of The American College of Lifestyle Medicine (ACLM). Lifestyle Medicine (a.k.a Preventive Medicine) involves the therapeutic use of lifestyle, such as a predominately whole food, plant-based diet, exercise, stress management, tobacco and alcohol cessation, and other non-drug modalities, to prevent, treat, and, more importantly, reverse the lifestyle-related, chronic disease that’s all too prevalent.

Lifestyle Medicine / Preventive Medicine is the future of healthcare—true “health” care dedicated to identifying and eradicating the cause of disease, as opposed to simply diagnosing and treating, too often medicating established disease.

As a member of ACLM, Dr. Citrin is contributing to redefining health care with a focus on treating the causes. ACLM members are united in their desire to be the tip of the spear in ushering in a transformed system of care delivery that enables sustainable human health and a sustainable healthcare system: They share a passion for using lifestyle as a therapeutic intervention to prevent, treat and, often, even reverse lifestyle-related diseases.


1.Kung, H.C., et al., Deaths: final data for 2005. National Vital Statistics Reports 2005: Available from:

2.Mathers, C.D. and D. Loncar, Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med, 2006. 3(11): p. e442.

3.Murphy, S.L., J.Q. Xu, and K.D. Kochanek Deaths: final data for 2010. 2010.

4.Go, A.S., et al., Heart disease and stroke statistics–2013 update: a report from the American Heart Association. Circulation, 2013. 127(1): p. e6-e245.

5.Chobanian, A.V., et al., Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension, 2003. 42(6): p. 1206-52.

6.Vasan, R.S., et al., Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: a cohort study. Lancet, 2001. 358(9294): p. 1682-6.

7.Services, C.f.M.a.M., National health expenditures aggregate, per capita amounts, percent distribution, and average annual percent growth, by source of funds: selected calendar years 1960–2007. 2008, Baltimore, MD: Available from:

8.The Organisation for Economic Co-operation and Development (OECD), Health at a Glance 2011 – OECD indicators. 2011, Organisation for Economic Co-operation and Development, Paris.:

9.Anderson, G., Chronic conditions: making the case for ongoing care. . 2007, Baltimore, MD: John Hopkins University.

10.Ciemnecki, A.B., et al., National Public Engagement Campaign on Chronic Illness – Physician Survey. 2001, Mathematica Policy Research, Inc.

11.Goldman, D.P., et al., Substantial health and economic returns from delayed aging may warrant a new focus for medical research. Health Aff (Millwood), 2013. 32(10): p. 1698-705.

12.Arena, R., et al., Healthy Lifestyle Interventions to Combat Noncommunicable Disease-A Novel Nonhierarchical Connectivity Model for Key Stakeholders: A Policy Statement From the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine. Mayo Clin Proc, 2015. 90(8): p. 1082-103.