Multiple Chronic Conditions: The Real National Emergency Calls for Bipartisan Resolve

Figure 1. Percentage of U.S. Adults with Multiple Chronic Conditions by Number of Chronic Conditions (2018), Christine Buttorff et al., RAND Corporation, TL-221-PFCD, 2017 (available at
Figure 2. Health Care Spending by Number of Chronic Conditions (2014), Rand Corporation (Buttorff, Ruder, & Bauman, 2017, p. 16)
  • The Legislative path must focus on rules and regulations to protect citizens and consumers by increasing transparency about food nutrition and by enforcing smoking cessation.
  • The Promotional lane must incentivize employers with tax benefits for wellbeing programs and facilitate insurance affordability and accessibility.
  • Prevention and Treatment of multiple chronic conditions are limited to unilateral efforts exerted by a health sector based on a linear project or program concept. They run parallel but lack the seeds for sustainment.
Figure 3. The “Black Box” phenomena (Image © Asaad Taha 2014).
  1. They should start with understanding their circumstances and goals (issue-based).
  2. They should gather in-depth information (evidence-based) about the best investments where there are high sustainable yields (planning).
  3. Successful investors should have an appetite for risks, a willingness to allocate some money for startups stocks (innovative).
Figure 4. The proposed system is a strengthening framework to bridge the gap between NCD investments and results. (Image © Asaad Taha 2014).
  1. A Trans-Disciplinary Framework capable of empowering wide-range adopters by providing an inventory of evidence-based toolkits representing the best-of-the-best known global practices.
  2. A Strategic-Execution Framework to translate strategy into sustainable benefit realization and results;
  3. A Problem-Solving Methodology to link intended changes, benefits, and strategic objectives; and
  4. A Sustainable Systems-Strengthening Framework balancing business-as-usual and investments in transformational change.
Figure 5. The twenty subcomponents (Steps) of the proposed delivery system. (Image © Asaad Taha 2014)
Figure 6. S4F.Solutions™ Human-centered Design Framework. The framework is a sub-step of the proposed delivery system twenty steps and overarching framework for S4F.Solutions™ Scaled Agile Methodology for design thinking and human-centeredness (Image © Asaad Taha 2014).
  • Robust mandates and drivers for transformational change and measurable impacts;
  • Clear strategies and objectives to achieve their desired goals; and
  • Accountability to deliver Value for Money (VfM) with sustainable results.
Figure 7. S4F.Solutions™ Transformation change Framework Benefits. (Image © Asaad Taha 2014)
  1. Broad-based, multi-sector mandate: A National Health Coordinating Authority requires legal status and a formal mandate defining the authority’s governance structure, accountability, capabilities, and parameters. It will clarify the autonomy of its actors specifying their reporting lines to multi-agency authorities, federal and state parties, private-sector partners, community-based organizations, non-formal, and other civic entities. And, it must specify areas of accountability in terms of policy implementation, partner inclusion, and prevention activities outcomes and goals for every actor.
  2. Consensual oversight: The Coordinating Authority must have trusting relationships enabling policy synergism, resources optimization, and oversight, including regular information sharing and reporting.
  3. Empowering ownership: The Coordinating Authority must have a clearly defined role including “custodial functions” for an agreed-upon NCD Strategic Action Framework (NCD-SAF). This will require developing, negotiating, monitoring and evaluating the NCD-SAF. After coordination and implementation, the authorized actors would coordinate the resource mobilization and optimization determined by national priorities. And, NCD-SAF would seek federal budget supporting of its core operational expenditures.
  4. Serving umbrella functions: A National Coordinating Authority must earn the trust of partners and funding mechanisms within the Action Framework. It must demonstrate credibility by committing to broad inclusion and participation, including full membership by actors. Each of these partners, in turn, must accept and respect the NCD-SAF and the role of the Authority. The Authority must assure partners of their organizational independence to serve their own mandates. It must assure partners no partnership of funding mechanism has privileged ownership of the Authority. And, it must require stakeholders to cooperate within the shared framework of monitoring, evaluation, and accountability.
  5. Enabling partnership arrangements: Any such Authority requires a broader, enabling, organizing mechanism. This common arena must be accessible and inclusive. Partnership arrangements must encourage leadership, provide a vision for expanding NCD-SAF funding through Medicaid and Medicare and guiding existing and emerging funding mechanisms.
  1. Priorities: Any framework must incorporate clear priorities for resource allocation and accountability, making it possible to link priorities and resource equity, based on the national priorities and outcomes/results-utilization.
  2. Reviews/Consultation: The framework must offer systems ensuring regular joint reviews and consultation on the progress including all partners and actors.
  3. Commitment to coordinate: All actors in the U.S. must organize within the action framework consistent with their organization’s mandates.
  4. Linkages: Any framework that would align with Healthy People 2030 must recognize connections and interdependencies between public and private sector health activities, interventions by Department of Health and Human Services (HHS) and Centers for Disease Control and Prevention (CDC), and multi-sectoral and crosscutting activities.
  5. Managing partnerships: The framework must affirm and optimize the growing drive to engage health actors and the private sector in productive partnerships.
  1. Best Practices alignment: Stakeholders and actors must align their efforts to ensure accountability for achieving the Healthy People 2030 goals. They must agree on core elements of a nation-level MER₂L system that addresses these needs.
  2. National system linked to the NCD-SAF: Under the leadership of the National Coordinating Authority, the NCD-SAF should be supported by a core system for monitoring progress towards achieving NHS and the Healthy People 2030 goals.
  3. Agreed investment strategies: National-level stakeholders should prioritize assessments of existing MER₂L systems. Stakeholders should agree on how systems can be improved and how to set up a shared core system that provides high-quality data to analyze country performance.
U.S. Border Patrol stands watch during border fence reinforcement. In Nov. 15, 2018 photo U.S. Border Patrol Agents at Border Field State Park in Imperial Beach watch over personnel that are reinforcing the border fence with concertina wire. (Photos: Mani Albrecht /



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Asaad Taha, PhD

Asaad Taha, PhD


A Social Entrepreneur | Futurist|Principal Advisor @ S4F™ Solutions™