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  • The Time is Right for "Preventionists" in Health Care

     By Ron Loeppke, MD, MPH, FACPM, FACOEM 

    Paula Span’s recent article in The New York Times raised legitimate points about the need to reduce health care costs by focusing on the quantity and quality of medical care (“Do Hospitalists Save Money?” August 12, 2011). However, while these elements of evidence-based medicine are very important, they focus only on patients who are already sick and overlook the critical question: How do we help people remain well and avoid getting ill in the first place? Ben Franklin provided the answer more than 250 years ago when he said “an ounce of prevention is worth a pound of cure,” but as a nation, we still don’t seem to be getting the message.   

    Why is it that after all this time, preventive medicine has yet to be seen as the best medicine? Instead of debating the effectiveness of treating illness by hospitalists (or other medical specialists) isn’t it about time that we recognize the incalculable value of maintaining wellness through the work of “preventionists” — who represent the medical specialty of preventive medicine?   

    If we examine the facts, there is no longer any question that in order to achieve true and sustainable cost control, we must transform our nation’s treatment-centric sick care system to a true “health” system built on the pillars of prevention.   

    Today’s health care cost crisis is largely a consequence of a health crisis due to unhealthy lifestyle decisions and actions made throughout our society on a daily basis. Chronic conditions account for 75 percent of health care costs and 70 percent of deaths in the United States. In fact, 96% of all Medicare expenditures are spent on these chronic conditions that have lifestyle health risk factors impacting their development. Ironically, the CDC reported that up to 40% of cancer cases — as well as 80% of diabetes and heart disease cases — could be prevented if Americans did not smoke, ate healthy and exercised adequately.    

    We could salvage Medicare for Americans if we just made a concentrated effort on prevention. Imagine the increased availability of financial and clinical resources, the enhanced capacity of physicians and hospitals and the strengthened safety net throughout our health care ecosystem if we could begin to reduce the burden of illness and health risks that are currently leading to this epidemic of chronic illness in our society.    

    The clinical science of preventive medicine focuses on wellness and health promotion and health risk assessment to keep people healthy (primary prevention); and early identification/diagnosis of illness through age/gender/risk appropriate screening and biometric testing (secondary prevention); as well as earlier evidence-based intervention/treatment to deter complications and the disabling impact of conditions (tertiary prevention). The preventive health care movement reaches well beyond the four walls of medical facilities to include workplace health and community health initiatives. 

    There has never been a better time to focus on prevention, and there are some encouraging signs that we might finally be moving in that direction. Michelle Obama is helping lead the way with her specific efforts aimed at the obesity crisis we are facing in this country. There are significant planks for prevention built into the Affordable Care Act, which promotes evidence-based clinical prevention with incentives and grants for comprehensive workplace wellness programs; incentives for local governments to improve community wellness; science-based nutrition information for families; and health screenings with personalized prevention plans covered by Medicare. And the Act also established a National Prevention Council to develop a National Prevention Strategy, rolled out by Surgeon General Regina Benjamin, MD, in June of this year. 

    Preventive health care enjoys broad bipartisan support. According to a public opinion survey released by Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation, about 71 percent of Americans favor increased investment in disease prevention. 

    So let’s take prevention to the next level: The task now is to develop a national prevention strategy that aligns the views of most Americans with the policy and funding necessary to move toward a culture of health, personal responsibility and wellness. Everyone can participate in this effort, including the nation’s employers — who can support prevention and enjoy the benefits of a healthier workforce by implementing comprehensive workplace wellness programs. In fact, a Harvard University study found that medical costs fall by about $3.27 and absenteeism costs fall by about $2.73 for every $1.00 spent on well designed workplace prevention and wellness programs. 

    The time for preventionists has arrived. Rather than merely rationalizing the volume of medical services as costs to be justified, we should focus on realizing the value of prevention services as investments to be leveraged through workplace health and community health initiatives. Keeping more people well would unleash financial and clinical resources to better care for those that are ill. In doing this, one of the most relevant outcomes would be on individuals — helping them avert a personal crisis, prevent a chronic illness and add not only a greater quantity of years to their life, but moreover, a higher quality of life to their years. At a higher level, this effort can help reduce the burden of risk and illness to our entire society, improving the health and productivity of our nation’s workforce, the profitability of engaged employers and, ultimately, the vitality of our nation’s economy. 

    (Dr. Loeppke is Vice President of the American College of Occupational and Environmental Medicine and Vice Chairman US Preventive Medicine.)