The
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c i m e o n v i o t ec pera of im
[ PREVEnTIVE
MEASURES
The CDC director argues that it’s in the national interest in terms of money and lives to focus on prevention. Excerpt from “Thomas Frieden,” July 23, 2010. Thomas Frieden M.D., M.Ph., Director, Centers for Disease Control and Prevention; Administrator, Agency for Toxic Substances and Disease Registry
T
here are enormous economic as well as health benefits from prevention. While ultimately it’s the health benefits that are our strongest case, we also – given the economic context that we are in – have to think hard about the economic case for prevention. There are a series of factors that affect health. The most basic are socio-economic determinants of health: poverty, education, housing, equality; the things that are the substrate in which health occurs. At the level above that are initiatives that can be thought of as traditional publichealth initiatives. Changing the context, so that the default decision is the healthy decision. Clean water, clean air, food that is iodized and water that’s fluoridated. One level above that are long-lasting, protective interventions: immunization, brief intervention for alcohol, cessation of tobacco smoking, colonoscopy. One level above that are clinical interventions that require long-term, consistent care,
such as treatment for high blood pressure and high cholesterol and diabetes. And one level above that are counseling and education interventions to encourage people to eat healthier or be physically active. In general, the lower you are on that pyramid, the more effective your intervention. But every level of that pyramid will be potentially essential and important to address different health problems. There are some problems for which we only have counseling and interventions, and therefore we have to emphasize them. By making communities healthier, prevention can be a best-buy. It can increase the health value we get for our health dollars. It can reduce the per-capita annual health-care costs. And the Affordable Care Act expands the coverage for preventive care, increases funding for prevention, and supports the public health infrastructure. The most important means to improve health within the clinical context are what I call the ABCS – aspirin, blood pressure,
cholesterol, and smoking. A-B-C-S. And on the ABCS, the USA gets an F, currently. Of everyone for increased risk for heart disease, the proportion on an aspirin a day is 33 percent. Of everyone with high blood pressure, the proportion who have it under control is 45 percent; of everyone with high cholesterol, it’s 29 percent; of all the smokers who try to quit, only 20 percent get help – in fact, only 2 percent get medications, which would double or triple their likelihood of succeeding in becoming tobacco-free. That’s despite spending one out of every six dollars of our entire economy on health care. It would be difficult to spend this much money and do worse at the most important things we need to do. There are, I believe, in both the community sphere and the clinical sphere key winnable battles, things we can make a big difference in, but they’re not going to be easy. I want to discuss very briefly six of them: tobacco, obesity, health-careassociated infections, motor vehicle injury
feb r ua ry/mar ch 2011
THE COMMO N WE AL TH
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