An Unhealthy America: The Economic Burden of ... - Milken Institute

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An Unhealthy AmericaMilken InstituteEmotional DisturbancesGDP:In 2003 the total indirect impacts based on GDP amounted to $170.9 billion. In 2023, the baseline scenarioincreases to $568.5 billion; the optimistic scenario increases to $480.2 billion. Also in 2023, the difference betweenthe baseline and optimistic scenarios themselves comes to $88.0 billion, reflecting a difference of 15.5 percent.The cumulative avoidable indirect impact based on GDP over the twenty-year period is $601.0 billion.Wages: Total indirect impacts based on wages in 2003 amounted to $76.0 billion. In 2023, the total increases to $245.3billion in the baseline projection and $207.2 billion for the optimistic scenario.IndividualCaregiverLost Workdays Presenteeism Expenditures Lost Workdays PRC* Expenditures/PRCPresenteeismTotalYear Baseline Disease Optimistic Baseline Optimistic (Billions) Baseline Optimistic (Millions) Baseline (Thousands)Optimistic Baseline Optimistic2003 18.9 18.9 137.4 137.4 1.4 1.4 13.2 13.2 170.9 170.9Cancer 48.1 10.6 4.52023 62.8 55.1 457.2 384.2 4.6 4.0 43.9 36.9 568.5 480.2Percent Change Breast Cancer 5.5 1.1 4.82003-2023 232.6 191.5 232.7 179.6 232.9 191.2 232.3 179.3 232.7 181.0Source: Milken InstituteGDP-Based GDP-Based Indirect Indirect Impact Impact Projections Projections for Emotional for Emotional Disturbances - US$ BillionsUS$ BillionsColon Cancer 3.9 0.3 11.5Lung Cancer 6.3 0.4 17.1Prostate Cancer 4.3 1.0 4.1Other Cancers 28.0 7.7 3.6Wage-Based Indirect Impact Projections for Emotional DisturbancesWage-Based Pulmonary Indirect Conditions Impact Projections 45.2 for Emotional 49.2 Disturbances 0.9 - US$ BillionsUS$ BillionsDiabetes 27.1 13.7 2.0IndividualCaregiverHypertension 32.5 36.8 0.9Lost Workdays Presenteeism Expenditures Lost Workdays PRC* Expenditures/PRCPresenteeismTotalYear Baseline Disease Heart Disease Optimistic Baseline Optimistic (Billions) 64.7Baseline (Millions) Optimistic 19.2 Baseline (Thousands) Optimistic 3.4 Baseline Optimistic2003 Cancer Stroke 8.4 8.4 61.1 61.1 48.1 13.6 0.6 10.6 2.4 5.9 4.5 5.6 5.9 76.0 76.02023 27.0 Mental Disorders 23.7 197.4 165.9 45.8 2.0 30.3 1.7 18.9 1.515.9 245.3 207.2Percent Change Breast Cancer 5.5 1.1 4.8Total 277.0 162.2 1.72003-2023 223.0 Colon Cancer 183.0 223.0 171.4 3.9222.5 182.7 0.3 222.5 11.5171.1 223.0 172.8Source: Milken Institute PRC: Lung Population Cancer Reporting Condition 6.3 0.4 17.1Prostate Cancer 4.3 1.0 4.1Other Cancers 28.0 7.7 3.6Emotional Pulmonary DisturbancesConditions 45.2 49.2 Emotional Disturbances0.9GDP-Based Diabetes Avoidable Indirect Impact 27.1 Wage-Based 13.7 Avoidable 2.0 Indirect ImpactEmotional DisturbancesEmotional DisturbancesGDP-Based Hypertension Avoidable Indirect Impact 32.5 36.8Wage-Based Avoidable 0.9 Indirect ImpactUS$ Billions Heart Disease 64.7 US$ Billions 19.2 3.4100Expenditures PRC* Expenditures/PRC40Stroke 13.6 2.4 Expenditures 5.6 PRC* Expenditures/PRCDiseaseExpenditures (Billions) (Millions) PRC* Expenditures/PRC(Thousands)Mental Disorders Disease 45.8 30.3 (Billions) 1.5 (Millions) (Thousands)Disease Cancer80(Billions) 48.1 (Millions) 10.6 (Thousands) 4.5Total Cancer 277.0 30 162.2 48.1 1.7 10.6 4.5Cancer Breast Cancer 48.1 5.5 10.6 1.1 4.5 4.8PRC: Population Reporting Condition Breast Cancer 5.5 1.1 4.8Breast Colon 60 Cancer 5.5 3.9 1.1 0.3 4.8 11.5Colon Cancer 3.9 0.3 11.5Colon Lung Cancer 3.9 6.3 0.3 0.4 2011.517.1Lung Cancer 6.3 0.4 17.1Lung Prostate Cancer 40 Cancer 6.3 4.3 0.4 1.0 17.1 4.1Prostate Cancer 4.3 1.0 4.1Prostate Other Cancers 4.3 28.0 1.0 7.7 4.1 3.6Other CancersOther Cancers1028.0 7.7 3.6Pulmonary 20 Conditions 28.0 45.2 7.7 49.2 3.6 0.9Pulmonary Conditions 45.2 49.2 0.9Pulmonary Diabetes Conditions 45.2 27.1 49.2 13.7 0.9 2.0Diabetes 27.1 13.7 2.0Diabetes Hypertension027.1 32.5 13.7 36.802.00.9Hypertension 2005 2008 2011 32.5 2014 2017 36.8 2020 2023Hypertension0.920052008 201132.52014 201736.82020 20230.9Heart Disease 64.7 19.2 3.4Source: Milken InstituteHeart Disease Source: Milken Institute 64.7 19.2 3.4Heart Stroke Disease 64.7 13.6 19.2 2.4 3.4 5.6Stroke 13.6 2.4 5.6Stroke Mental Disorders 13.6 45.8 2.4 30.3 5.6 1.5Mental Disorders 45.8 30.3 1.5Mental Total Disorders 277.0 45.8 30.3 162.2 1.5 1.7Total 277.0 162.2 1.7Total PRC: Population Reporting Condition 277.0 162.2 1.7PRC: Population Reporting ConditionPRC: Population Reporting Condition[ 157 ]
An Unhealthy AmericaMilken InstituteState-Level Avoidable Indirect ImpactsAlthough every disease category is projected to cause a rise in avoidable direct impacts—the economic toll of lostworkdays and lowered productivity—the state rankings experience no change due to those impacts over the period2003–2023. In general, a state’s score depends on the relative distribution of future GDP or wage rates, its employedpopulation, and disease-specific PRC totals, which cause most of the variation between baseline and optimistic scenarios.When a state ranks high for disease-specific indirect impacts despite having a low PRC, the ranking is attributable tohigh GDP or wage rates. The following table depicts states that rank at the top and bottom of per capita projected GDPand wage rates in 2023.Projections of GDP and WagesProjections of GDP and Wages - Per Capita, 2023Per Capita, 2023Top 5 States Expenditures PRC* Bottom 5 Expenditures/PRCStatesDisease GDP Wages (Billions) (Millions) GDP (Thousands)WagesCancer Delaware Colorado 48.1 West Virginia 10.6 Montana 4.5Breast Connecticut Cancer Nevada5.5 Montana 1.1 West Virginia 4.8Colon Massachusetts Cancer Delaware3.9 Mississippi 0.3 Mississippi 11.5Lung Cancer New York Connecticut6.3 Oklahoma 0.4 Louisiana 17.1Prostate California Cancer Washington4.3 Arkansas 1.0 Oklahoma 4.1Other Sources: Cancers U.S. Census, Economy.com 28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9Diabetes 27.1 13.7 2.0Hypertension 32.5 36.8 0.9When a state ranks low Heart for Disease disease-specific indirect impacts 64.7 despite having 19.2 a high PRC, the 3.4 ranking is attributable to lowprojected GDP or wage Stroke rates. Again, the net effect depends 13.6 on the relative 2.4 strength of GDP 5.6 or wage rates, and PRC.Mental Disorders 45.8 30.3 1.5Projections of the labor Total force size will also influence 277.0 avoidable indirect 162.2 impacts and some 1.7 variations among staterankings.PRC: Population Reporting ConditionEmployment and PopulationEmployment and Population - Projected Rankings, 2023Projected Rankings, 2023Top 5 States Expenditures Bottom PRC* 5 States Expenditures/PRCDisease Employment Population (Billions) Employment (Millions) Population (Thousands)Cancer California California48.1 Wyoming 10.6 Wyoming 4.5Breast Cancer Texas Texas 5.5 Vermont 1.1 North Dakota 4.8Colon Cancer Florida Florida 3.9 Alaska 0.3 Vermont 11.5Lung Cancer New York New York 6.3 North Dakota 0.4 Alaska 17.1Prostate Cancer Illinois Illinois 4.3South Dakota 1.0 South Dakota 4.1Other Sources: Cancers U.S. Census, Economy.com28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9Diabetes 27.1 13.7 2.0Hypertension 32.5 36.8 0.9Heart Disease 64.7 19.2 3.4Stroke 13.6 2.4 5.6Mental Disorders 45.8 30.3 1.5Total 277.0 162.2 1.7PRC: Population Reporting Condition[ 158 ]
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