Why Prevention can save the world

I’ve had a lot of time to truly reflect on my thoughts about health. When I was little, I’d always thought that health was simply the absence of disease. Since then, I’ve come to understand that it’s far more complicated than I ever imagined. Not only because health involves physical well being, but also because so much of health is mental: the emotions, anxieties, and worries that can come with it.

Sometimes I think current world health problems are so vast that it feels impossible to fix. The global and local disparities are horrifying, and spending is only getting worse. Death and disease disproportionately affect racial and ethnic minorities and the world’s poor due to lack of access and education. Although these groups bare a larger chronic disease burden, the issues affect  all of us.

Cancer is rampant in the US, occurring in 1/3 women and 1/2 men. Obesity rates are through the roof and only getting worse. Heart disease is the number one cause of death. What do these things have in common?

They are all, to a certain extent, preventable. 

There will always be some instances of chronic disease that have nothing to do with individual lifestyle factors (stemming from genetics, environment, etc), but the following statistics might convince you about the extent to which high ranking diseases are tied to lifestyle.

If everyone in the United States lived a healthy lifestyle*:

• 80% of cases of heart disease and diabetes, 70% of stroke cases, and just over 50% of cancer cases would be avoided.

 

How is it that our government spends more on healthcare than any other country, but ranks far lower in population health status? We pour tons of money, time, and energy into treating really sick people, but don’t stop to think about the bigger picture. It’s far more economical to think of ways we can prevent people from getting so sick in the first place.

 

Here’s the problem: only 3% of government spending in healthcare is devoted to prevention. Three percent. Clearly there is a disjoint between how much of a difference prevention can actually make and what is spent on it.

 

With a greater investment in prevention, we have the ability to see meaningful changes over time. We can be saving lives. We can be helping people. So, what’s the deal?

 

Prevention is invisible. We can’t see tangible benefits. No one wants to go to the doctor if “nothing is wrong.” It gets dismissed and shoved to the back burner, particularly when other things in life get in the way. Yet prevention is SO cheap compared to tertiary and emergency care.

 

The good news is that the status of prevention is about to change with the current healthcare bill. Now, I know the Affordable Care Act has brought a lot of controversy with it. I’m not going to try and debate the pros and cons of the entire ruling. But I do want to highlight a few things that will be SO important to improving the health of the population through prevention.

 

The Affordable Care Act sets up a new Prevention and Public Health Fund designed to expand and sustain healthcare services that prevent disease, detect it early, and manage conditions prior to becoming severe.  This new initiative will not only improve health and healthcare quality, but will also increase the national investment in prevention and public health. Already, President Obama has announced that $250 million will go towards educating primary care physicians, and an additional $250 million towards community/clinical prevention, public health infrastructure, research, and public health training.

 

In addition, many preventative services will be completely covered under all insurance plans. This effectively removes one of the primary barriers to healthcare: cost. The more difficult task will be to improve access.

 

This is a great, albiet long explanation of how much the investment in public health is needed. People have been lobbying for this kind of political action for years, and it’s very exciting to see that changes are actually happening.

 

Now, I’m not an idealist. I fully recognize that no matter what the government does, it is insanely difficult to get individuals to change their behavior. If person X wants to eat fast food everyday and fully understands what the consequences of doing so might be, then that is person X’s choice. All we can do is spread the word, educate, and help others. I don’t think we’ll ever get to a point where we eliminate all preventable cases of disease, because people are left to make their own lifestyle choices.

 

But we also can’t ignore the fact that thousands of people don’t actually have a choice. Many families below the poverty line are often forced to make poor diet choices because they cannot afford healthier foods. Poorer families also tend to live in unsafe neighborhoods, making outdoor exercise very difficult. Most don’t have cars, so getting around is also a challenge. While current advances in politics will help with preventative care issues, we still have a very long way to go in terms of framing our thinking about health in a lifestyle context.

 

Despite the barriers, I really believe that prevention can save the world. Though we are making huge strides in the US, there are still other areas of the world that are in dire need of help. Many of these areas have very different disease problems compared to the US, but they still stem from inadequate preventative measures. Furthermore, significant work needs to be done to help break down other barriers to healthcare (like access and social norms) as well as healthcare disparities.

 

With that, I’ll leave you with some ideas about how to live a healthy lifestyle. I’m not trying to preach, by any means, as it’s every individual’s choice as to whether he or she wants to “be healthy.” I respect your choices and opinions. This list will simply explain what I mean by the preventable statistics I provide above.

 

 
*What constitutes a “healthy lifestyle?”

1. Maintain healthy weight
2. Exercise regularly
3. Don’t smoke (anything)
4. Maintain a healthy diet (fruits, veggies, and proteins)
5. Drink alcohol only on occasion, or not at all
6. Use sunscreen
7. Use protection if sexually active
8. Get screening tests!

This last one is so important, because many diseases don’t necessarily have symptoms. The earlier something is detected the more likely you are to have a better prognosis. So annual doctor visits are important!