remington-portrait-2

Patrick Remington, MD, MPH, is editor of “Chronic Disease Epidemiology, Prevention and Control, Fourth Edition.” Photo courtesy UW School of Medicine and Public Health

Patrick Remington, MD, MPH, professor and associate dean for public health at University of Wisconsin-Madison’s School of Medicine and Public Health, has spent many years researching ways to improve public health surveillance methods and outcomes. Editor of the new edition of “Chronic Disease Epidemiology Prevention and Control,” Remington discussed with us the current knowledge and best practices in the prevention and control of major chronic diseases and their risk factors.

Q: With our growing chronic disease epidemic, it seems the release of this book couldn’t be more timely. Agreed?

A: I agree. When the first edition was published in 1993, we could never have predicted that obesity rates would increase so dramatically, leading to higher rates of diabetes and other related chronic diseases. Our society has transformed in ways that make the “healthy choice the harder choice” given few opportunities for physical activity in daily living and the evolution of the fast food environment. Perhaps more importantly, we still have a “fee-for-service” health care system that mostly thrives on the care and treatment of chronic illnesses, with few if any real incentives for prevention.

Q: You’ve added “prevention” to the title with this edition. Why?

A: Just as the CDC has become the “Centers for Disease Control and Prevention,” we added “prevention” to the title of our book to recognize the importance of “moving upstream” in our work to reduce the burden of chronic diseases. This is the first edition of the book where we used the “river metaphor” for the chronic disease continuum, and organized the chapters into three distinct sections. We begin with chapters on chronic disease “upstream risk factors,” such as smoking, physical activity and nutrition. This is followed by chapters on related “midstream chronic conditions,” such as obesity, high blood pressure and high blood cholesterol. The end of the book contains the related “downstream chronic diseases.” We hope this format encourages practitioners to think first about the upstream causes.

 

The new edition tackles some of the most important and vexing public health problems of our time, including how to cope with the rising tide of chronic illness. Photo courtesy of APHA Press

The new edition tackles some of the most important and vexing public health problems of our time, including how to cope with the rising tide of chronic illness. Photo courtesy of APHA Press

Q: What else is new since the last edition?

A: As we began to think about a comprehensive approach toward chronic disease prevention, we looked to the model that we developed here at the University of Wisconsin for the County Health Rankings. We realized that we were missing chapters that addressed the more than half of the determinants of chronic diseases — the health care system, and social and economic factors. So we tapped Dr. Maureen Smith and our Preventive Medicine Resident Karina Atwell, and they wrote an excellent chapter entitled “The Role of Health Care Systems in Chronic Disease Prevention and Control.” And we also reached out to one of the nation’s leading scholars in this field, Dr. Paula Lantz, and she and her team (Carlyn Hood and Parvathy Pillai) wrote an outstanding chapter entitled “The Social Determinants of Chronic Disease.” With these two new chapters, the book now addresses most of the determinants of chronic diseases in the U.S.

Q: It’s brilliant to hear you talk about this text as a chronic disease compendium to APHA’s venerable “Control of Communicable Diseases Manual.” Can you explain?

A: When I was a medical student, I did a 1-month, 4th-year elective rotation at the Wisconsin Division of Public Health, working with Drs. Jeff Davis and Jim Vergeront. Knowing nothing about public health — and relatively little about infectious diseases at the time — I bought a copy of the 13th edition of Benenson’s then-titled “Control of Communicable Diseases in Man.” It contained everything I needed to know about infectious diseases, and was constantly at my side as I continued my public health career.

When I began my position as the director of Wisconsin’s Chronic Disease program, I realized that there was no similar reference for chronic diseases. That’s when my colleague Ross Brownson and I began to plan and eventually edited the first edition of Chronic Disease Epidemiology and Control — using a very similar “handbook” format as was used in Benenson. Our hope at the time, and still today, is that students and young public health professionals find this book as valuable as I found Benenson’s CCDM to be.