An Ounce Of Prevention For The Debate On Health Care Reform

August 06, 2009|By Robert S. Gold

Even as the debate over health care reform reaches a fever pitch, significant questions about the future of public health and medicine in our nation remain unanswered. From public options to universal access, proposals and plans to help Americans live longer and healthier lives are seemingly all on the table, and yet amid all these ideas, an absolutely necessary part of our public health future - prevention - seems to be lost in the shuffle.

The simple act of changing our lifestyle for the better can dramatically improve our quality of life and lessen our health care expenses, and it's a renewed emphasis on prevention programs that will bring true reform to our health care system.

The need for a greater emphasis on prevention starts with the glaringly high level of chronic diseases, including heart disease and cancer, affecting people in Maryland and the wider U.S. The vast majority (about 75 percent) of each health dollar goes to treating chronic conditions, and yet heart disease and cancer rate as the top two causes of death in our state and the nation, according to the Centers for Disease Control and Prevention (CDC).

What's most frustrating is that these two diseases - along with diabetes, the incidence of which has risen roughly 40 percent in the last 10 years - are largely preventable and stem from lifestyle problems such as obesity and physical inactivity and are made worse by disparities in access to medical care.

Preventive measures can help fight these problems - improved diet and exercise as well as kicking the smoking habit can dramatically decrease a person's risk of heart attack and stroke, and more frequent screenings such as mammograms can increase the ability to fight cancer.

Not only does prevention lead to healthier people, it also leads to healthier wallets. According to a study from the non-partisan Trust for America's Health, an investment of $10 per American in prevention and public health programs would generate savings of more than $16 billion in five years - that translates to a return on investment of more than 5 to 1.

These programs work, and I've seen their results here at the University of Maryland. A recent study by one of our faculty did what could be considered impossible - convincing kids to eat more vegetables. They did this by showing the children different ways to prepare fruits and vegetables and inviting the children to taste them, effectively improving their overall nutrition and hopefully inculcating healthier eating habits for years to come.

Whether viewed through the lens of economics or health care, prevention programs make sense.

Yet they represent only a small fraction (just 4 percent) of what the U.S. spends on health care each year. In Maryland, this produces alarming results: the CDC states that as many as 60 percent of colorectal cancer deaths could be prevented if people 50 and over received regular screenings, and yet one in three adults over 50 have never had a sigmoidoscopy or colonoscopy. Sixty-three percent of adults are either overweight or obese, and 73 percent of adults eat fewer than five fruits and vegetables per day.

Thankfully, the health care reform bill currently before Congress makes several key investments in preventive care, and those pieces of the larger bill must be maintained.

But, in a larger sense, a greater investment must be made to create a culture of prevention in our society, one that rewards those who make significant health changes to their lives and provides incentives for those who need an extra push. Of all the reforms on the table, more prevention is the best option for the future.

Robert S. Gold is the dean of the University of Maryland School of Public Health. His e-mail address is

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