January 13th, 2010
Americans IGNORE prevention
JoAnne M. Foody, MD
The American Heart Association has issued its Heart Disease and Stroke Statistics 2010 Update, which underlines the fact that most Americans are ignoring prevention. While more than half a trillion dollars is spent annually on heart disease, little is spent on prevention. What can we do to change this? If more money were available for prevention, how do you think it would best be spent?
5 Responses to “Americans IGNORE prevention”
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Pre-Health Care Dollars
I would spend it all on services or organizations that would be expected to improve community health, before an individual even walks into a physician’s office: more money towards menu labeling programs, more money towards food stamp programs (1in 8 Americans now receives food stamps, including 1 in 4 children) so that healthier foods can be purchased as opposed to McDonald’s dollar menu foods and the like, more money towards school physical education programs and facilities to encourage regular daily activity as part of a normal lifestyle, and more money toward anti-tobacco programs for kids and young adults. To me, I would expect these “dollar” investments to have a disproportionately large return (hopefully!!).
I agree. I think community based participatory research is be a great venue for screening and prevention. Another important aspect is advocacy. Corn-based products are highly subsidized, and make high calorie foods very cheap as a result. I also think it is important to better understand in detail why people make decisions for unhealthy lifestyle, and qualitative research into patient choices should go hand in hand with interventions such as education campaigns. I think we can all agree education is good; however, the methods of most effective and cost-efficient delivery, especially to those with low education, can/should be further developed.
so what are you proposing…
Am curious about Joanne’s piece — where would you direct funds? What would you take it away from? What is the biggest leverage investment for prevention? The challenge is that interventions for low risk people tend to have a benefit for the population but many of the individuals will not benefit.
Where to invest
We’ve know since autopsy studies on adolescent Korean War casualties, and had it confirmed by studies like PDAY, that risk factors in young people produce atherosclerosis by age 15, and predict clinical events in middle age and beyond. Given the terrifying explosion of obesity, hypertension, diabetes, and physical inactivity in the US today – amply quantified by the 2010 AHA statistics – the underlying burden of disease can only be worse. Given this, I agree that primary prevention – starting as early as possible and using the community resources outlined in earlier comments – is the way to go. However, given the prevalence of these risk factors and unhealthy life style habits in the parents, finding ways to engage them is equally important. So, in response to Harlan’s question, and knowing what does and does not most effectively shape behavior, I would invest the hypothetical “new dollars” in creating financial incentives for families, care-givers, and community services. Extend “P4P” programs to pediatricians, schools, and families. Give tax credits to families whose total “family poundage” drops, or who produce evidence of cigarette cessarion, or who can demonstrate validated attendance at exercise facilities. Put work-out clubs in neighborhoods where access to such services is typically limited by cost or convenience. Reward commercial gyms who give discounted memberships to those who can demonstrate fiscal hardship. Nothing less than a “community approach” to prevention will work.
It’s all a matter of the patient’s belief system. The human mind is constructed to fasten the seat belt 10 seconds before the car crash, and does not worry about events 20 years in the future. BTW, based on the Korean War autopsy studies about atheromatous intima, why don’t we urge a daily glass of wine beginning at age 12 to ameliorate this propensity? You cannot prescribe to a patient any action or drug that goes against his/her belief: I have some patients who don’t “believe” in sleeping pills. I also have some females whose husbands don’t “believe” in sleeping pills, so they buy them theirselves without filing thru their husband’s drug plan. And we all have patients who don’t “believe” in vaccines. This resistance to good health habits is almost never rational, so logical arguments rarely work.