Book lays out framework for tackling chronic illness

The numbers are startling.

Chronic illnesses afflict an estimated 129 million Americans and cause roughly 70% of all deaths nationwide. Of the more than $4 trillion spent each year on healthcare in the United States, 90% is incurred by people with chronic and mental health conditions.

These statistics and many more like them illustrate the staggering toll of chronic disease documented in a new book by Carl Cranor, a distinguished professor emeritus of philosophy at UC Riverside.

"Vital Lives: Social Responsibility and the Battle Against Chronic Disease" (Oxford University Press, 2026) asserts that healthcare systems, regulatory agencies, and legislative bodies must take a more active role in managing and mitigating this runaway health crisis.

Individual efforts to prevent and forestall chronic diseases are necessary but not sufficient, Cranor argues, given these conditions generally stem from multiple, interacting causes, which he groups into four categories:

1. biological processes associated with aging;
2. individual lifestyle choices, such as exercise, diet, tobacco use, and excessive alcohol consumption;
3. involuntary exposure to toxic substances;
4. and social determinants - the economic, environmental, and social conditions in which people live.

Combating these diverse causes requires a more comprehensive and coordinated approach to healthcare than what exists now, Cranor argues.

A legal and moral philosopher, Cranor, 82, has written extensively on the ethical and legal issues that arise from exposure to toxicants. His books include "Toxic Torts: Science, Law and the Possibility of Justice" (Cambridge University Press, 2008, 2016), "Regulating Toxic Substances: A Philosophy of Science and the Law" (Oxford University Press, 1993), and "Legally Poisoned: How the Law Puts Us at Risk from Toxicants" (Harvard University Press, 2011).

He recently spoke with UCR News about the book's genesis, the impacts of chronic illness, and his proposed framework for promoting what he calls "vital lives."

1. What inspired you to write this book?

I've written numerous books and articles about how toxic substances can sicken us and often shorten our lives. I thought I should write a book with a more upbeat emphasis.

My experience as a runner and admiration for the work of James Fries steered me toward the topic of preventing chronic illness. Fries was a rheumatologist and Stanford professor. He was an influential advocate for healthy aging, and his work resonated with me.

In the 1970s, he discovered an intriguing correlation: In a database of patient records, he observed that exercise and a healthy diet were tied to significantly more years of vigorous life but to only modestly longer lifespans. People with healthy and unhealthy lifestyles lived, on average, about the same number of years, but individuals who exercised and ate well tended to stave off chronic diseases until much later.

Fries practiced what he preached: He climbed the highest peaks on six continents and ran numerous marathons. I felt he was a kindred spirit; I was an avid runner and climber, too.

Yet, as I explored chronic diseases, I found influences beyond poor individual behaviors that contribute to them. I had to broaden my scope of research, which brought into focus the need for collective efforts to improve living conditions, improve access to medical care, and reduce toxic exposures, which can trigger chronic conditions. Thus, my personal interest in running and hiking, along with my background in moral and legal philosophy about toxic exposures, assisted with a more comprehensive strategy to address chronic diseases.

2. How did you land on the book's title, "Vital Lives," and what do you mean by it?

I wanted the focus of the book to be not only about decreasing mortality rates of chronic illness, though of course that's important, but also on living a life in which you have energy and can flourish for as many years as possible. In the introduction, I discuss the centenarian cyclist Robert Marchand and the runner Jeannie Rice, who, at 77, recently finished her 134th marathon. Their examples and others demonstrate how being healthy can allow you to be active and pursue your interests even as you reach an advanced age.

To quote myself from the book, "Good physical health anchors life's possibilities and supports one's chosen life course. It's a near-universal means for pursuing personal projects and goals."

Now, contrast the examples of Marchand and Rice with those of Carla Bartlett and Brian Milward, who both contracted cancer due to exposure to toxic chemicals - Milward at work; Bartlett from drinking tap water. They will likely be encumbered by cancer for the rest of their lives. Chronic disease not only increases your risk of premature death but can accelerate aging, restrict activity, and lead to suffering and dependency.

3. When I think of what causes chronic illnesses, toxicants don't spring to mind. I generally think of things like genetic predisposition, a poor diet, and lack of exercise. What are some of the long-term risks of exposure to these kinds of substances?

Cancer is probably the best-known one, but exposures to toxic chemicals can trigger or spur the development of many other diseases, including diabetes, emphysema, cognitive disorders, liver diseases, and atherosclerosis. Toxicants are commonly overlooked contributors to chronic illnesses. Wildfire soot, heavy metals, plastics, industrial chemicals - they can all be involuntarily inhaled or ingested.

For example, people generally don't realize when they're exposing themselves to groundwater contamination. Think of the case that made Erin Brockovich famous. Toxicants pose major health risks, especially if people are exposed to them regularly. Often, these exposures are beyond the control of individuals and require action from other actors, such as the government and industry.

4. Is this what you refer to as the "social division of responsibility"?

Yes. The idea I advance in the book is that, rather than leaving chronic disease prevention primarily to individuals, different institutions should each address the risks they are best positioned to control. Physicians can promote prevention and early detection, regulators can reduce toxic exposures, researchers can identify emerging risks, policymakers can shape healthier social conditions, and individuals can pay attention to health information and avoid known hazards

For maximum effect, however, there needs to be a better flow of information and cooperation among healthcare providers, scientists, public health officials, regulators, and policymakers. These actors need to see themselves as health trustees, by which I mean joint stewards of public health, and eschew narrow economic interests or political pressures in favor of long-term population health goals.

5. If you had to prioritize one intervention to foster vital lives, what would it be and why?

Individuals, at least those in favorable circumstances, can make choices to avoid imbibing toxins, eat healthy foods, forgo tobacco, and have an appropriate exercise routine to support better health.

Perhaps the best course of action is for the public to support the extension of affordable healthcare coverage to people not in advantaged positions in society. A large consensus recognizes that the U.S. has the worst healthcare coverage of our peer countries. People and groups should focus their attention and political influence on the need for improved healthcare for all adults, children, and pregnant women, which would help fill gaps in healthcare coverage and reduce some of the maternity care deserts, which currently are in one-third of the country, concentrated in rural areas.

To achieve the benefits of broader good health, we need to demand more of our healthcare and health-protective institutions. I would also encourage the public to ask their congressional representatives to support or initiate legislation for pre-market reviews of chemical products analogous to, but not identical to, reviews of prescription drugs.

(Header photo: Getty Images/Ivan Pantic)