On occasion, your correspondent fights the northeast’s dreary weekend winter evenings with a dram of spirituous liquor like Macallan 12. Unlocked with a small splash of water and a single ice cube, a generous ounce of that pungent cinnamon leathery elixir turns the cold into cozy.
So naturally, your correspondent relies on spouse to help keep a therapeutic stock available. Both yours truly and spouse run errands and it shouldn’t be too hard for either to be proactive by periodically checking supplies, buying some Macallan when necessary and avoiding the unhappiness of a dispirited and cold author.
Unfortunately, spouse doesn’t always see it that way.
Welcome to the complicated world of behavioral economics. It tells us that it’s difficult for persons to expend effort today to reduce the tomorrow’s risk of an unlikely event. It’s why many persons chose to not take or pay for medications today to reduce the distant likelihood of disability or early death. There’s more on the topic here.
This also explains why persons don’t do a good job getting a flu shot for themselves or their loved ones. Check out this interesting information from athenahealth. According to their pooled electronic health record (EHR) data, 2.5% of children without a flu shot came down with the flu, versus only 0.9% of those who got the shot. While getting a shot reduced the relative risk of coming down with the disease by approximately two thirds, the vast majority of kids who went without immunization (97.5%) did OK. Data from the CDC in adults reflects the same kind of numbers: 80% of persons in the U.S. do not come down with the flu in the course of the year.
How can the population health and care management community leverage behavioral economics to increase immunization rates?
In 2003, 168 countries signed the world’s first public health treaty: the Framework Convention on Tobacco Control (FCTC). The FCTC legally bound countries to enforce major tobacco control measures, ranging from tobacco taxes to regulations on public smoking. Through a massive international effort, the FCTC has assisted countries to improve their tobacco prevention programs, and the treaty continues to be a basis for many new programs that are implementing evidence-based tobacco control strategies.
In an article in PLoS Medicine, we publish new data showing that the food and beverage industry’s activities in low- and middle-income countries parallel that of the tobacco industry in years past; moreover, as cardiovascular disease and diabetes rates rise in poor nations, junk food, soda, and alcohol are statistically the major factors giving rise to deaths among working-age populations, and the newest evidence suggests that educational programs alone aren’t effective when markets are drowned by imports of cheap, unhealthy food and readily-accessible booze. So should the public health community push for a nutritional treaty or governance structure that parallels the successful introduction of the FCTC, but addresses “unhealthy commodities” like junk food? If so, what would such a structure look like?
Zooming out from the debates about soda taxes and similar public health controversies that pit individual freedom against public health desires to reduce disease rates, there are really a few core public health problems now facing global food systems: (1) that undernutrition and famine persist as over-nutrition (malnutrition in the direction of obesity) has appeared in the same poor households in many countries; and (2) that climate change has forced us to think about how to produce food for the world’s 9+ billion people in a manner that is environmentally sound (as highlighted in our recent discussion of Oxfam’s GROW campaign).
“I will prevent disease whenever I can, for prevention is preferable to cure.” These are the words of the Hippocratic Oath, an ancient vow that has been recited by physicians for centuries. However, with seven out of 10 deaths in America attributable to largely preventable chronic illnesses, including heart disease, stroke, chronic lung disease, diabetes and some types of cancer, we have yet to see these words put into practice. Such is the history of our nation’s health care — or, perhaps more appropriately, “sick care” — system, where 75 percent of today’s U.S. health care dollars are spent on chronic illness and only three to five percent to prevent these diseases. Until now. As implementation of the recent health-reform legislation begins, our nation is finally putting prevention into practice. By providing significant financial support for preventive services and programs, the Patient Protection and Affordable Care Act (ACA) builds the foundation for a prevention revolution and moves our country closer to making Hippocrates’ vision a reality today.
Thanks to the new law, patients now will receive free preventive services at the doctor’s office. The ACA mandates that private health insurance plans established since March 23, 2010, must cover, without cost sharing, the services recommended by the U.S. Preventive Services Task Force. Additionally, as of September 23, 2010, all insurance plans must include these preventive services with their annual enrollment cycle except for those plans that have been grandfathered. This requirement will also apply to Medicare by the year 2011 and to Medicaid on a state-by-state basis. Recent research has shown that providing just five of these services — colorectal and breast-cancer screenings, flu vaccines, counseling on smoking cessation and regular aspirin use — could avert as many as 100,000 deaths every year. As a result of these new provisions, millions of Americans will now have free access to these preventive services and others, including additional cancer screenings, routine check-ups, vaccinations, prenatal care, and counseling regarding smoking, alcohol use, nutrition and obesity. This expansion of coverage represents a leap forward in our nation’s shift towards a prevention-oriented health-care system, to the benefit of millions of people. However, what happens in the clinic is only one element of a comprehensive public health approach that is needed to make this transformation a reality.