FOCUSING SUFFICIENT RESOURCES, PROMOTING
CREATIVE, EFFECTIVE EFFORTS IN WELLNESS AND
PREVENTING ILLNESS AND INJURY, AND MAINTAINING A HEALTHY
LIFESTYLE.
In the past century, significant improvements have been made in preventing
disease. Improvements in personal hygiene, environmental sanitation, and control
of communicable diseases were startling and revolutionary events occurring
more than fifty years ago. Within this decade, most medical advances have been
in the areas of new drugs and medical procedures. While these are important
improvements, a disproportionate share of focus and resources are currently
directed toward treatment of health conditions rather than preventing ill health,
injury, and disability.
Public health experts estimate that 50 percent of all U.S. deaths are preventable.
In spite of this knowledge, we continue to experience high rates of morbidity
and mortality caused by chronic and communicable diseases and injury. There
is scientific proof that most preventable deaths can be attributed to nine
causes: tobacco, diet and activity patterns, alcohol, microbial agents, toxic
agents, firearms, sexual behavior, and abuse of drugs (McGinnis & Foege, 1993).
Even with the improvements in health achieved locally, there were more than
an estimated 16,000 preventable deaths in Travis County over the past ten years.
A misleading model that is continuously reinforced by the traditional medical
establishment and related interests in the United States is that access to
and use of medical services are the best approach for improving the health
status of individuals and the overall population. Proponents of this model
believe that more and better medical care means healthier people. The fallacy
here is that the services that Americans call health care are only indirectly
related to health. Rather, they are directed toward disease (or ill health)
and relate to health only to the extent that they can restore persons to health
and normal functioning (Turnock, 1997). Conversely, prevention services characterize
actions that are taken to reduce the possibility that something will happen
or in hopes of minimizing the damage that may occur if it does happen.
Prevention strategies are generally divided into two types of activities:
health promotion and health protection. Health promotion activities attempt
to modify human behaviors or reduce those behaviors known to adversely affect
a person's ability to resist disease or injury. Specific protection activities
provide individuals with resistance to factors, such as microorganisms, or
modify environments to decrease potentially harmful interactions with health-influencing
factors such as toxic substances (Turnock, 1997).
Limited information is available on expenditures for prevention and prevention-related
services. The Health Care Financing Administration (HCFA) annually estimates
the total national expenditures on health. However, HCFA information on prevention
expenditures is limited because of cost definitions, unclear demarcations between
categories, and the availability and accuracy of secondary data sources. A
1988 study showed the national investment in prevention to be estimated at
less than 5 percent of the total annual health care cost (Centers for Disease
Control and Prevention, 1992). As part of the development of a national health
reform proposal in 1994, federal officials estimated less than one percent
of all national health expenditures supported prevention related programs and
services (Core Functions Project, 1993).
The HCFA 1998 report on National Health Expenditures states that national
health expenditures topped $1.1 trillion, up 5.6 percent from 1997. HCFA estimates
that the amount an individual spent on health care increased by $182 to $4,094
(Health Care Financing Administration, September 2000). In the absence of local
data, the HCFA estimate on spending per person ($4,094) and the estimated 1998
Travis County population (709,692) can be used to estimate health care expenditures
in Travis County. By multiplying the two figures together, the formula estimates
that $2.9 billion is spent on health care in Travis County. Optimistically
speaking, if two percent of the total health care expenditures were spent on
prevention services in Travis County, prevention expenditures would be $58.1
million or less.
Typically, public health prevention measures its victories by the illnesses,
injuries, and deaths it prevents. Because health care resources are limited,
public health efforts must focus on prevention strategies that yield the most
benefit for the investment. The Centers for Disease Control and Prevention
published a report in 1999, An Ounce of Prevention: What are the Returns,
that outlines 19 strategies for and economic benefits of health promotion and
disease and injury prevention. The strategies demonstrate how spending money
on the prevention of disease and injury and the promotion of healthy lifestyles
makes good economic sense. Each prevention strategy was evaluated based on:
- the health impact of the related disease, injury, or disability on U.S.
society;
- the effectiveness of the prevention strategy;
- the costs of the disease, injury, or disability; and
- the cost-effectiveness of the strategy (Centers for Disease Control and
Prevention, 1999).
For example:
- Some childhood vaccines save up to $29 in direct medical costs for each
dollar spent.
- Chlamydia and its complications cost the U.S. approximately $2.6 billion
each year. Universal screening and treatment for chlamydia of women aged
15 through 20 years in STD and family planning clinics with a 6.6 percent
prevalence of chlamydia infection would save $900 to $1,000 for each case
of chlamydia identified and treated.
The World Health Report 2000, Health Systems: Improving Performance,
ranks the U.S. as spending more per capita on health care than any other country
but ranked the U.S. health system 37th in overall performance. This demonstrates
that the United States is willing to invest many resources for health but perhaps
these resources are not utilized in the most effective manner. "We have focused
too long on how technology can help diagnose and treat disease and not long
enough on how science and technology can prevent disease and help us control
the cost of health care," states John H. Gibbons, Ph.D., Assistant to the President
for Science and Technology and Director of the Office of Science and Technology
Policy (Turnock, 1997).
Prevention efforts are frequently taken for granted and go unnoticed in our
daily lives because their success lacks the drama and excitement of curative
efforts. Prevention efforts often lack active public support because their
results are unseen. Prevention strategies are not only the best approach for
improving the health of individuals and the community but do so in economically
responsible ways. Many current prevention strategies offer excellent opportunities
to promote good health at a reasonable cost.
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