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Defending the benefits of prevention

Last February, the New England Journal of Medicine ran a potentially misleading review of the cost-effectiveness of illness prevention strategies that may have led many casual readers (such as the editors of the Washington Post Health section) to conclude that most health-improving measures — such as aggressive counseling for people who are either overweight or smoke — cost more in the long run than they are worth. This week’s Journal of the American Medical Association carried a proper antidote by Steven H. Woolf of Virginia Commonwealth University, who is fast becoming a leading expert on prevention techniques for improving the nation’s health.

Woolf admits that personal behavior is difficult to change, and many intervention strategies for preventing disease cost more money for the health care system than they save. But he takes direct aim at the NEJM article claim that "drew similarities between the cost-effectiveness ratios of prevention and disease treatments, all but ignoring the much lower cost-effectiveness ratios of the preventive services that guidelines advocate."

But touting those physician-delivered prevention services that are
cost-effective is not the core of his argument. The health care system
is the improper vehicle for delivering the most cost-effective
preventive services and strategies, he argues. "Behavior change occurs
where people live — at home, work and school — but the community
offers little infrastructure for modifying lifestyle."

Advertising, school lunches, restaurant menus, entertainment media,
convenience technologies, and the built environment discourage physical
activity and promote consumption of calorie-dense foods, large
portions, tobacco, and alcohol. Social conditions (eg, inadequate
education, impoverished communities) impose additional barriers.

Boosting prevention is only partially a question of how our society
allocates its health care system resources. A properly defined
prevention campaign requires tackling issues that lay beyond the health
care system. Imagine calorie counts on every fast-food and chain
restaurant menu. Imagine rejuvenated big city public health departments
sending skilled nutritionists bearing dietary advice and training into
low-income neighborhoods suffering from some of the nation’s highest
obesity rates.

Giving people the tools to help themselves lose weight is the first
step in the process of reversing the nation’s obesity epidemic. (A new
study
, also published in today’s JAMA, showed the rate of childhood
obesity has finally stopped growing, but about a third of all kids are
still either obese or overweight, about triple what it was in the 1960s
and 70s.)

Woolf’s hope is that the demonstrable effect that deteriorating
health is having on longevity and the economy will generate the
political will to act. "Self-interest (living longer and healthier) and
common interest (economic stability) may inspire the personal sacrifice
of getting healthy and the collective sacrifice (by the private sector
and the state) of mobilizing the resources to make it happen," he
concludes.

Merrill Goozner spent more than 25 years in the news business as a
foreign correspondent, economics writer and investigative reporter. In December 2003, he joined the Center for Science in the Public
Interest as director of the Integrity in Science project, where he
continues his research and writing. He blogs regularly at gooznews.

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7 replies »

  1. We don’t know when the medical problems are came, but we have to ready to meet these problems, and also we have to try to prevent through avoid alcohol, junk foods, over weight. Eat healthy, Do exercise and Live happy.

  2. Hi!
    I do agree prevention is much better especially in the world we are living today with the amount of stress levels and everything we all are goin through. I have diabetes and have it under control by lowering my sugar content and exercising and using various affirmative mantras. Well about the sugar, I use purple in my alcoholic drinks or smoothies as it is sugar-free and helps prevents cancer because of itz antioxidant punch of 7 fruit juices. I thought may be this information helps everyone. Anyway in case you want to check it out itz…. http://www.drinkpurple.com
    Prevention is better trust me!!!!

  3. Hi Peter –
    “Of course I don’t have a family history of rare diseases or other health problems other than old age.”
    Neither did I. Out of the blue, as it sometimes is. Health care ought to be availale to those who need it because we’re supposed to be a humane, democratic society and this stuff really can happen to anybody.
    I think prevention’s important too. Even though my own healthy lifestyle didn’t work for me, that’s an anecdote. Statistically, it has to help a lot. But my guess is that the health insurance companies are pretty limited in what they can do to influence individuals to adopt healthy lifestyles.
    Paul – originalfaith.com

  4. Sorry to hear about your experience with U.S. Healthcare Paul, the, “best system in the world”. I realized the health insurance scam a number of years ago and am now happily uninsured while putting former premiums into my own health savings account AND doing all I can to eat right, exercise and overall stay healthy. I sleep nights with more piece of mind than health insurance provides. Of course I don’t have a family history of rare diseases or other heath problems other than old age, that’s a big difference.
    “many intervention strategies for preventing disease cost more money for the health care system than they save.”
    Really, or do they just have the potential to cost the companies that market health destroying products their bottom lines. I’d like to know how proper eating with a safe food supply and exercise cost more money to society than paying for unhealthy outcomes. Whose/what costs are being included? Taxing calories and using that revenue to promote healthy life styles and treatment would be one big step in paying for better health, and a recognition that bad habits produce bad outcomes. But like a $2 per gallon tax on gasoline after 911 would have done more to fight terrorism and pay for better fuel efficiency and, in the long run, saved us all money and lives, we won’t see any long run strategies from our “leaders” on healthcare. But politicians don’t live in a “long run” world, and neither do voters who can’t see past next week’s paycheck and would rather allow themselves to be gulled into voting for religion and guns than the real issues that affect their lives. Onward Christian Soldiers.

  5. I spent my adult working life as a healthy person paying insurance premiums until age 37 when I was stricken by a progressive, incurable illness that was in no way shape or form related to my behavior. (No drugs, alcohol, lifelong moderate jogger, never a weight problem.) The time since then was spent first struggling for retention of coverage of one kind or another for over a decade to finally be effectively denied all medical treatment.
    “Wellness benefits” usually strike me as sales pitches targeting healthy, premium-paying members of an unsuspecting general public that can little imagine the hell that awaits them if they happen to come down with an illness that health corporations find inconvenient to their bottom line and that they can easily avoid responsibility for because, for example, it’s rare, they’ve stuck the necessary loopholes into their legal obfuscations, and there’s little public outrage concerning people with rare diseases precisely because they’re rare – even though, in total, millions of Americans suffer from a large number of different rare diseases.

  6. The use of preventive medicine is very costly across the board. However, what needs to be done is to have individuals take a more active role in their individual care and health status. There are tools out there to allow patients to have more choices in their care. Unfortunately, they expect the physicians to make the healthy choices for them.

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