Monday, June 02, 2008

JAMA Commentary on Prevention

The latest issue of the JAMA has an interesting Commentary Article by Steven H. Woolf entitled "The Power of Prevention and What It Requires". Here is a sample:

Benjamin Franklin's adage that an ounce of prevention is worth a pound of cure is worth remembering at this worrisome time for health care and the economy. The prevalence of chronic illnesses in the United States is projected to increase, from 133 million persons in 2005 to 171 million in 2030.1 Health care spending accounts for 16% of the gross domestic product and may reach 25% by 2025.2 Rising health care costs are eroding corporate profits and threaten Medicare solvency, state budgets, pensions, and the viability of employer-sponsored health insurance.

....Even though disease prevention has its limitations, its potential benefits are profound. Chronic diseases, which account for 75% of health care expenditures,4 are precipitated by modifiable risk factors. The relationship between the obesity epidemic and diabetes incidence is illustrative. Targeting risk factors such as obesity can influence disease rates and costs on a scale that few biomedical advances can match. A new diabetes drug can make headlines if it reduces glycohemoglobin levels by 0.5%,5 whereas exercise can lower the incidence of diabetes by 50%.1 Four health behaviors (smoking, diet, physical inactivity, and alcohol use) account for 38% of all US deaths.1 Other forms of primary prevention can intervene more dramatically, as when vaccines all but eradicate infectious diseases. Secondary prevention (screening) can reduce colorectal and breast cancer mortality by 15% to 20%.

....Turmoil in health care and the economy may be shifting the dynamics for health promotion and disease prevention. Policy makers speak more about prevention, although the gestures are piecemeal (eg, better insurance coverage). History teaches that citizens and leaders make sweeping changes when they sense a mutual threat. Lifestyles change and schisms give way to accommodation when national security feels threatened (eg, wartime, climate change). Finding the economy and public health in decline may be what rouses the public to get serious about prevention. Self-interest (living longer and healthier) and common interest (economic stability) may inspire the personal sacrifice of getting healthy and the collective sacrifice (by the private sector and the state) of mobilizing the resources to make it happen.