OP-ED

Prevention is Not Only Good Health Policy, It’s Good Economic Policy

W3956 The current debate around how to best control burgeoning health costs has  pushed the issue of prevention to the forefront. That’s right where it should be. By shifting our health care to be more pro-active and prevention-oriented, we can make a major impact on common and costly chronic diseases such as diabetes. In turn, this will help to secure the financial stability of our health care system and continued economic growth and prosperity.

Over the past century, the burden of disease among Americans has shifted from acute and infectious illness to chronic disease. With more than 75 cents of every dollar in this nation spent on patients with chronic disease, prevention offers the opportunity not to spend more money — but spend smarter. By embracing prevention, we can help more Americans lead healthier, active lives free from disease, so that they can avoid costly complications and hospitalizations, and remain productive in their communities and workplaces.

Prevention today involves a lot more than flu shots, cancer screening, and annual checkups. It is a pro-active strategy of disease avoidance and mitigation that should be embraced throughout and beyond the health system. In the context of chronic illnesses such as asthma, cancer, depression, heart disease and diabetes, prevention runs the gamut from lifestyle changes to screening for risk factors and symptoms, to early intervention to slow or reverse disease, to active management of already present cases.

The case of diabetes — one of the fastest growing and most-threatening chronic conditions in the U.S. — provides perhaps the most compelling example of our opportunity. For most individuals who progress to type 2 diabetes, the disease can be prevented or delayed significantly by following a well-established routine of diet and exercise. The potential impact of such an approach is enormous, both in terms of lives saved, and dollars saved.

Consider the economic impact alone. On average, diabetes patients have medical expenditures 2.3 times higher than those of other patients of the same age. With the incidence of diabetes expected to double worldwide by 2030, it is not only a medical necessity but an imperative to identify those at highest risk and implement disease prevention strategies.

Fortunately, we now have the tools to do just that. Recent advances in understanding the biological complexity of human disease have transformed our ability to predict and prevent the onset of chronic diseases such as diabetes. Where previously we had one somewhat inadequate tool for measuring diabetes progression — the fasting glucose test — today we have sensitive diagnostic tests capable of measuring a wide range of biological processes implicated in the advance toward diabetes. As a result, physicians can identify those patients at highest “near-term” risk for diabetes — and target intervention efforts to them.

Stratifying those truly at highest near-term risk among the 57 million Americans now considered to be “pre-diabetic” would streamline diabetes prevention, and allow physicians to focus their efforts on those most in need — thus transforming preventive medicine from a means to protect the general population to a truly personalized effort to fight disease in at-risk populations.

This fundamental shift would pay substantial long-term dividends in reduced medical expenditures, improved patient quality of life and improved workplace productivity. Economic research unveiled at the most recent American Diabetes Association meeting shows that such a prevention strategy would be cost-effective in the near-term, and actually save the health care system money over the long-term. Likewise, the Diabetes Prevention Program administered in community based settings — a well-recognized “gold standard” — illustrates that cost-savings can be achieved in two to three years.

Effectively adopting such a strategy requires a new approach throughout the health care system, from physicians whose familiarity or comfort with new technologies can be slow to develop; to professional organizations who can be slow to adopt changes that deviate from the status quo; to private insurance companies and government health plans, whose reimbursement support for physicians and patients who adopt such tests and prevention strategies into clinical practice is critical.

Health reform opens the door to making true progress on prevention. On the other side of the door lies better health for our entire population — and a healthier, more vibrant economy. To get there, we must embrace policies that make it easier for patients to actively prevent and manage disease — as well as those that encourage health care providers to collaborate on care of chronically ill patients and take steps towards paying for outcomes and not just volume of services.

These types of “game changers” are required to set us on the right path for our health and our economy by providing better results for all our health care spending.

Emory university’s Dr. Kenneth Thorpe is the Robert W. Woodruff Professor and Chair of the Department of Health Policy & Management. Dr. Thorpe is currently executive chairperson of the Partnership to Fight Chronic Disease. In the early 1990s he served as a health care advisor to President William Jefferson Clinton.

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kiramatali shahAKAWRJIm GlinnBen Recent comment authors
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kiramatali shah
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kiramatali shah

1. There’s a movement to radically change California government, by getting rid of career politicians and chopping their salaries in half. A group known as Citizens for California Reform wants to make the California legislature a part time time job, just like it was until 1966.
leatest trend

AK
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AK

I agree with those who have commented that prevention does not just mean better screening for chronic conditions and cancers. I believe it does begin with lifestyle changes- eating healthy, exercising, reducing stress, wearing seat belts, etc. However, this is, indeed easier said than done. Yes, it must be difficult for doctors to try to convince patients to make healthier choices, but what happens when patients do not even have choices because of circumstances and environment? We must consider the additional factors that could contribute to the difficulty of making healthy choices, especially when socioeconomic status is concerned. What if… Read more »

AWR
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Ironically, one of the problems with wellness and health in the USA is the vast array choices. A lot of the products and services that are offered are nothing more than fancy packaging and labels. From yoga and pilates to acupuncture and chirpropractors, it is nice to see that a variety of health and wellness options are available. However, like anything else, education and careful discretion is advised. Don’t believe the hype – do your research and you can find good, inexpensive wellness options almost anywhere. I’ve started using somibo.com – a good site where you can find lots of… Read more »

JIm Glinn
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MD as HELL may indeed be correct in the comment about trying to save people from themselves. Our Team (Ex Physiologist, Physical Therapists and MD’s) have put together a FREE site that provides a daily prescription of what we deem the lowest level of movement needed to obtain basic benefits of “prevention.” It gets some use, but nowhere near what it should/could. We thought we were going to radically change the lives of so many but have found the behavioral side very challenging! http://www.movementforlife.com We can tell people what to do, provide them with tools to do it and it… Read more »

Ben
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Ben

MD as HELL, this has absolutely nothing to do with evolution. Lower-class obese people have plenty of kids in their teens, 20s, and 30s before they have a chance to die in their 50s and 60s.
If bad-health people live to be 58 on average, and good-health people live to be 116, that doesn’t change the fact that bad-health couples can have 3 kids each and good-health couples might only have 1 or 2.
Human evolution is dead, and has been for some time.

MD as HELL
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MD as HELL

The fastest way to a healthier population is to get out of the way of evolution and let the gene pool improve. Quit trying to save people from themselves. You can’t!

MG
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MG

Agreed that this is a somewhat disingenuous article. The only kind of “preventive medicine” that generally universally says money is immunizations. For almost all of kind of preventative medicine, it depends on several factors that go into a cost-benefit/cost-effectiveness analysis.

ihealth 360
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The current debate around how to best control burgeoning health costs, has pushed the issue of prevention to the forefront. That’s right where it should be. By shifting our health care to be more pro-active and.

Peter
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Peter

The battle for the prevention of diabetes will not be won by the medical profession, it will be won when we change our food policy that allows advertising junk food to children and which subsidizes HFCS and beef production through subsidizing corn. High calorie/high sugar/high carbohydrates/high fat has become engrained in our food culture because it’s easy and cheap for corporate America to sell food that way, while they pass the costs onto the healthcare system.

Barry Carol
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Barry Carol

“More exercise, less smoking, drugs and alcohol, healthier food, safer sex, safer traffic: that provides a healthier population!” Most of us know all this without needing a doctor to tell us. For many, though, they’re easier said than done. Millions of smokers would probably love to quit and have tried unsuccessfully numerous times but, for whatever reason, can’t. Exercise takes time, effort and discipline. For the non-athletic among us, it’s not fun which makes it a slog. A lot of healthier foods don’t taste very good. On the positive side, seatbelt use is up to 84% and traffic fatalities in… Read more »

Lubke
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Prevention of chronicle disaeses starts with health promotion for all people: lifestyle – intervention: More exercise, less smoking, drugs and alcohol, healthier food, safer sex, safer traffic: that provides a healthier population! The problem is: our environment (physical and psychosocial) seduces us to live unhealthy. It’s not easy for all people to live your life healthy. Especially if your economic status is low. In Europe (I live in the Netherlands) we try to go further than community based prevention: Together with the local government and the food industry we try to make changes in the environment: to reduce the seduction… Read more »

Trevor de Koekkoek
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Let’s try to remember the definition of words when we talk about prevention. Mammography and other types of early detection screenings have nothing to do with prevention. They are detection devices to detect a disease already in progress.
True prevention lies in one’s own control in diet, exercise and avoidance of environmental influences. Changing our habits to a healthy lifestyle would have a dramatic reduction on the financial burden of care, but I’m not sure policy changes will bring about these types of changes.

LisaLindell
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“In order to effect change we need performance measurement and transparency” I agree

ihealth 360
Guest

This fundamental shift would pay substantial long-term dividends in reduced medical expenditures, improved patient quality of life and improved workplace productivity.

EllenR
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EllenR

I used to work with a fellow who’d had a major heart attack. He had a gut that hung over his belt in a major way. He couldn’t walk too far or his “ticker” would get out of wack causing him to have an elevated heart rate, get all sweaty (and smelly) and sometimes he’s pass out. To his credit, our instructions were not to call the rescue squad when this happened. He’d always come-to eventually. But he could walk to the sub shop, which he did everyday. He’d bring back a huge steak and cheese or a meatball sub.… Read more »