A Register editorial last month called attention to an important Congressional Budget Office report on health-care reform proposals.
The CBO report found that preventive care will not reduce health costs significantly. The report infers that, if people live longer, they may increase costs by receiving more in Medicare and Social Security benefits. The counter argument is: Dying early can save money.
An earlier essay by John R. Graham, director of health-care studies at the Pacific Research Institute, raised similar concerns about prevention. Graham has called investing in prevention a delusion in reducing the bill for chronic disease.
In seeking a major overhaul of health care, we may have become so embroiled in a discussion of health-care costs that we have forgotten a key expected outcome from a reformed system. The discussion needs to shift to the question of what can be done so that everyone can live long, healthy and productive lives. In this larger context, then, prevention, along with early intervention, policy change and chronic-disease management, can play a major role.
What has occurred in our state to support this viewpoint? The following are Iowa examples:
We know that the epidemic of overweight and obesity can be tackled effectively with comprehensive community wellness programs. Henry County has demonstrated what happens when schools, businesses and policymakers work together in developing a comprehensive community approach. The percent of students in grades K-12 with weight problems has dropped from 41 percent in 2005 to 33.4 percent in 2007. Ninety percent of students in these grades are asking parents for healthy snacks. Policy changes in the school lunch program and vending-machine selections are part of the major effort to keep children healthy. Henry County also has targeted families, employees, seniors and parents of young children for special attention.
The effectiveness of cancer prevention and early intervention initiatives by public health programs and partners can be documented by the number of lives saved. According to an Iowa Cancer Registry report, an estimated 3,066 Iowans have been saved between 1997 and 2005. The most lives saved are seen with prostate, colorectal, female breast and male lung cancers, which for years have been responsible for more than 50 percent of cancer deaths.
Managing chronic disease
While the number of Iowans with asthma has remained the same since 1999, better management of the conditions has contributed to an annual savings of $9.2 million in hospital costs. Reduction in hospitalizations indicates that asthma-management strategies are having an impact, especially among children under 4. In 1995, the hospitalization rate for asthma was 30.7 per 10,000 children. In 2006, the rate dropped almost 60 percent to 13.5 per 10,000.
Health policy change
The $1 tax increase passed by the 2007 Iowa General Assembly resulted in some major changes in tobacco use. The number of cigarettes sold between March 2007 and March 2008 dropped 36 percent. In 2007, according to the Behavioral Risk Factor Surveillance System data, 19.8 percent of adults reported smoking – the lowest percentage ever reported in the survey. Data released in January 2009 from another and more recent survey found that the percentage dropped to 14 percent, one of the lowest percentages of any state in the country. About 79,000 Iowans have stopped smoking in the last two years, according to preliminary data.
Benefits like these and related prevention initiatives go far beyond money saved. They mean that a 70-year-old can enjoy another 10 to 15 years of quality life because of better chronic-disease management and good health practices and that a teenager who never starts smoking can avoid the ravages of lung cancer and other chronic respiratory diseases as an adult. The 70-year-old and the teenager can be productive, contributing members of their community, state and nation. And this is really what good health policy is all about.
Tom Newton is director of the Iowa Department of Public Health. Contact: [email protected]