What’s driving rising rates of chronic disease in millennials?

Published October 25, 2019

Dr. Vincent Nelson is vice president of medical affairs for the Blue Cross Blue Shield Association (BCBSA). His clinical background gives him a unique perspective on a recent report about the declining health of millennials. In this conversation, Nelson shares his thoughts on what’s driving chronic disease rates, how the millennial generation’s unique needs require different approaches and how millennials have one of the greatest opportunities to shape the future of our healthcare system.

On chronic diseases

Health of America (HOA): Millennials show signs of chronic disease – and behavioral health conditions – at an earlier age than their Gen X counterparts did. What do you make of that?

Nelson: First, I think you are seeing a greater sedentary lifestyle in America, and that’s driving obesity. What I saw in clinical practice is that there is not a single disease state that is not made worse by being obese. 

With regard to behavioral health, I think there’s some good news. There may be higher prevalence of some conditions, but there’s less stigma around behavioral health conditions than there has been in the past. More people are seeking therapy. You also have to look at the fact that we have a lot more technology in our lives. I believe it’s increasing our isolation and adding stress and anxiety. Young people are judging themselves by what they see on social media, those constant images of perfection, and having a hard time turning off work to unwind.

On missing opportunities to detect or prevent health problems

HOA: Americans in general have high rates of chronic disease--often multiple chronic diseases. What’s different about the way – or when – these appear among millennials?

Nelson: On the behavioral health side, a lot of times it’s harder to detect mental health issues earlier on because they’re just construed as growing pains. Even though a millennial patient might be looking for help, they may go undiagnosed. 

On the physical side, I think physicians are not typically thinking of younger people as having signs of chronic disease. If a millennial goes for a physical, a doctor may not necessarily order blood work, because it isn’t indicated in certain age groups. So the signs of diabetes or other chronic problems might go undetected. 

I also think millennials have been affected by social determinants of health. They may have grown up or live in nutrition deserts or lack convenient access to healthcare. They may lack transportation. And they may not have grown up with the education they need to make healthy food and lifestyle choices using the resources they do have.

We need to find ways to empower them to chart their own path in healthcare, to get the care they need.

On reshaping healthcare for the next generation

HOA: What do you make of the fact that many millennials are not really engaging with the healthcare system until it’s too late? 

Nelson: This is a generation that focuses on convenience. Some may believe they’re healthy and overlook signs and symptoms they might not otherwise pay attention to. Seeing a primary care physician regularly can help build that continuity, help a physician spot trends and know when to intervene.
But knowing how to navigate our healthcare system can be complex. There are lots of different health plans. Some require a primary care physician, some don’t. And if a millennial does have a primary care provider, or PCP, he or she may find it difficult to get an appointment when it’s convenient or not know how to work with a PCP. I encourage having a PCP, because it’s been shown they can help prevent or manage chronic disease. That said, we have to give millennials the tools they need to establish these relationships.

HOA: What opportunities are there to stave off some of the more serious complications down the road?

Nelson: There’s a lot of opportunity now. I think this is where technology can make a huge difference. We know millennials are interested in convenience, and thankfully we are at the beginning of a revolution in how we deliver care: telehealth. Finding out who does that the best, partnering with them, partnering with employer groups to offer those programs can help. We’ve also been hearing that millennials want a human connection, but they’re comfortable if it’s virtual. Telehealth can facilitate that kind of connection, and even facilitate regular communication with the same provider. Virtually, that provider could help triage your symptoms and tell you whether you need a house call, an urgent care clinic or an emergency department, for example.  

Most importantly, I think millennials should feel empowered and not daunted by healthcare. They’re set to be the largest and most powerful generation in a while, and they have an opportunity to shape and influence the way healthcare is delivered. We embrace that opportunity and want to be part of the transformation process.

Learn more about how Blue Cross and Blue Shield companies are collaborating with businesses, health providers and more to improve the health of millennials.