New Opportunities in the Changing Landscape of Prevention

Excerpt of article by Derek Yach, MBChB, MPH, The Vitality Institute, The Vitality Group, LLC, New York, New York and Chris Calitz, MPP, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland published in The Journal of the American Medical Association (JAMA).

The focus of medical research has historically been on curative medicine, yielding better drugs, medical devices, and clinical procedures. Prevention science—the systematic application of scientific methods to the causes and prevention of diseases in populations—has yet to receive the necessary investment and support required to reduce the growing burden of largely preventable noncommunicable diseases (NCDs).

Human and Economic Burdens of Disease

Recent assessments of the burden of risk and disease found that morbidity and chronic disability account for nearly half of the US health burden.Despite the largest per capita health expenditure of all industrialized nations, the United States has fallen behind peer countries in terms of improvements in population health. Americans reach age 50 with a less favorable cardiovascular risk profile, lung disease is more prevalent and associated with higher mortality, and the death rate from heart disease is the second highest among peer countries. Leading NCD risk factors are unhealthy diets, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose levels, physical inactivity, and alcohol use.Many of these risks are amenable to preventive interventions based on behavior change, yet comprehensive action by development sectors across the economy to disseminate evidence-based interventions targeting these modifiable risks is inadequate. Furthermore, knowledge about effective prevention interventions for mental illness and musculoskeletal diseases is limited even as their contribution to chronic disability increases.

Noncommunicable diseases have been cited as major contributors to rising health care costs, which the Congressional Budget Office (CBO) projects will be the primary driver of national debt over the next 4 decades. The greatest increase in health care spending between 2000 and 2011 was attributable to drugs, medical devices, and hospital care, with the cost of treating NCDs estimated to exceed 80% of annual health care expenditure, whereas 3% was spent on public health and disease prevention programs.The National Institutes of Health estimates that 20% of its $30 billion annual budget is allocated to prevention; however, less than 10% is spent on human behavioral interventions that target the major modifiable risk factors.More investment in prevention science could lead to greater health gains at lower cost.

Read the full article here.

Research!America’s response to the Yach and Calitz article in JAMA:

The commentary by Derek Yach and Chris Calitz should be required reading for every federal policy maker.  Preventing disease is the best case scenario, not only for patients, but for taxpayers and the economy.  That’s because reducing the incidence of disease is more than a one-time cost-saving strategy; it actually bends the cost curve and helps individuals lead long, productive lives.  Yet the Prevention and Public Health Fund, which allocates grants to states to reduce the prevalence of NCDs,  has been a perennial target of lawmakers who seek every opportunity to defund it and prevention science as a whole continues to be a low national priority. That’s where advocates come in.  Prevention science is not going to flourish until Washington comprehends the return on investment.  Fighting for prevention science is not just right, it is essential.

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