It’s a fact: the global burden of disease has shifted from infectious to chronic.   The leading causes of death and disability around the world have changed from communicable diseases in children to non-communicable diseases in adults.  Heart disease, chronic respiratory diseases and diabetes are on the rise in all regions except sub-Saharan Africa.  If HIV/AIDS is considered a chronic infectious disease – as is increasingly the case – the tipping point becomes an avalanche.  Countries with public health infrastructures built around controlling infectious disease now face a monumental challenge: how to re-tool and re-design care to meet this exploding epidemic.

We, too, are experiencing this shift in our work. For the past two years, the most significant increase in usage of our Improving Chronic Illness Care website came from visitors in developing countries like Botswana, Zimbabwe, Bangladesh, and Namibia. Our tools and resources continue to be adapted, translated and used internationally: the Patient Assessment of Chronic Illness Care survey in China and Vietnam, adaptations of the Chronic Care Model in Uganda, Thailand, and Burma.

MacColl investigators continue their active engagement with international organizations in the development of  guidance and recommendations for improving the care of people with chronic illnesses.

Looking ahead, the Chronic Care Model continues to offer a way forward. There are lessons learned from our experiences in the United States and developed countries about what works and what not to do. Finally, there is much to learn from our worldwide colleagues as they develop their own unique and innovative approaches to improving chronic illness care.

Michael Parchman


  • Lancet. 2012 Dec 15;380(9859):2224-60. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lim SS, et al. [Link]
  • WHO 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases.  Geneva, World Health Organization, accessed January 23, 2014. [Link]


  • Patient Assessment of Chronic Illness Care (PACIC) [Link]
  • Vietnamese PACIC (Thăm dò Ý kiến về Tình trạng Bệnh mãn tính) [Link]
  • Chronic Care Model [Link]


  • Pan American Health Organization. Innovative Care for Chronic Conditions : Organizing and Delivering High Quality Care for Chronic Noncommunicable Diseases in the Americas. Washington, DC : PAHO, 2013. [Link]
  • USAID Health Care Improvement Project [Link]
  • Human Development Unit, East Asia and Pacific Region, World Bank (2011) Toward a healthy and harmonious life in China: Stemming the rising tide of non-communicable diseases. World Bank Report Number 62318-CN. Washington, D.C.: World Bank, 2011. [Link]
  • Chronic Care Model Implementation and Outcomes among Patients with COPD in Care Teams with and without Advanced Practice Nurses [Link]
  • Chronic disease management in the South-East Asia Region: a need to do more [Link]
Event Date: 
Mon, 02/24/2014