Keep Prevention In Health Care Reform

A recent headline saying that prevention is under attack as part of health care reform really bothered me.


 


One of my core principles as a physician has been that preventing illness when possible is much better than treating illness.  I can’t even begin to imagine a revamped health system that does not shift emphasis and money to prevent disease. Billions (if not trillions) for technology and machines and pennies for prevention is unbelievable and unacceptable.


 


Is our health care in this country technologically outstanding? Absolutely. You can’t find anywhere in the universe that has more fancy medical machines per person that the good old US of A. Giving us good value, effective care and long, healthy lives for the amount of money we are spending?  No way.


 


The only solution I have to improve my odds of living longer and healthier is to do whatever I can to take care of myself, and that means incorporating prevention into my daily life.  I happen to think that prevention is also the right prescription for the country.


 


Prevention has always been close to my heart professionally as well.


 


Years ago, I started my practice as a medical oncologist.  I transitioned from cancer medicine to primary care internal medicine because I believed in prevention.  I encouraged “primary” prevention (weight loss, healthy diet, exercise, stop smoking), and quickly came to realize that it was difficult to get people (including yours truly) to change their ways.  I accepted (and still do, since I need some help myself) that much of what I did as a doc had to be “secondary” prevention, including treating high blood pressure and cholesterol. But that didn’t diminish my efforts to encourage my patients to practice primary prevention as well.


 


Combined with screening, counseling, and a lot of cajoling I believed then and believe now that nothing works better to improve the health of large numbers of people than a focus on prevention through a culture of health.  People need to be encouraged to take charge of their health and surround themselves with a commitment to prevention and living a healthy lifestyle. 


 


But we don’t, and the results show up in all sorts of statistics: we are fatter, we are more sedentary, and we have increasing amounts of disease related to lifestyle issues. 


 


“Metabolic syndrome” is a term that didn’t exist in my dictionary when I was in practice.  Now we recognize it as one of the leading causes of diabetes, heart disease, elevated cholesterol and maybe even indirectly to cancer (14% of cancer deaths in men are related to overweight and obesity.  For women, the number is 20%).


 


So as we build our hospital beds larger and our fancy scanners bigger and as we fatten up as a nation and expect doctors to pull us back from the brink of disaster after disaster, we have lost sight of the fact that medicine can’t fix everything—even if we had all of the money in the world going to health care.  The path, as they say, is unsustainable and in no small part “we being us” is responsible.


 


There are many of us who believe the only way to get us back on track is to emphasize prevention as an intrinsic part of health care. We can’t prevent every illness or disease, and we can’t cure everything.  We could do a much better job on both counts, but ultimately it starts with us.


 


I promise you I know how tough it is to try to do the right things when it comes to prevention. 


 


I have tried and tried to lose weight, but keep getting stuck (I call it the “Groundhog Diet” after the Bill Murray movie “Groundhog Day” because I keep losing and gaining the same weight month after month).  But I won’t give up and I keep hoping that one day I will get it right. 


 


I try to exercise whenever possible, and now incorporate 10,000 aerobic steps into my day, even when I am travelling (which I do regularly).  I take my own cereal and fruit on my trips, so I don’t have to eat the hotel buffet breakfast—a sure place for disaster and pounds. On occasion I even pack some vegetables so I can eat better when I get to the hotel late at night. 


 


I avoid those little snack packs on the plane, which can add up if you have one of them on each leg of each flight.  I don’t have to worry about smoking (thankfully), but alcohol consumed wisely still adds on the pounds (2 jiggers of alcohol—which is about 3 fluid ounces– provides 240 calories.  If you do that 3 times a week, that’s 720 calories.  There are approximately 3500 calories per pound. That adds up to 11 pounds a year.  If you “pour heavy” or drink more than that, you can quickly see that’s a lot of weight.)


 


Why do all this?  And why keep trying even though I shamefully admit I am not successful in everything I try to do when it comes to prevention?


 


It’s real simple: I want to do what I can to stay well.  I am terrified of becoming another statistic in the large maw of our health care “system.”  If I do, I want to know that I did what I could to avoid the problem.  And I will keep on trying despite my very human limitations.


 


Prevention simply makes sense.  Is it free?  Some is, some isn’t.  Can we afford it?  My answer is how can we NOT afford it?  Does it belong in whatever health care reform we adopt? You betcha.


 


There are also community aspects to health-related prevention, and that in fact is what those headlines were about.


 


It turned out that the prevention issue in question was regarding funding for community construction projects designed to improve health, such as parks, bike paths, and local farmer’s markets. 


 


I can understand why there might be debate on that item, since some might think such infrastructure projects don’t belong in a health reform bill.  But that doesn’t mean they don’t work—they do.  There is research to back it up, and the public health and nutrition folks have been clamoring for attention to these “healthy community” investments for years.  So, in my personal opinion, it doesn’t make much difference where the funding comes from, so long as it comes from somewhere.


 


My hometown in southwest Georgia recently built just such a walkway (they also do an annual community-wide weight loss program which has been very successful). It surrounds a large water reservoir, and is exactly one mile in length.  My wife and I make it part of our weekend routine—weather permitting—whenever we are home, walking five or more miles on Saturday and Sunday.  And we aren’t alone, not to mention the families, friends and church groups that get together in the park for a picnic or to fish or just watch the birds or the other people.


 


We are also fortunate in our town to have a farmers’ market which has a large selection of inexpensive, fresh vegetables—another “prevention” strategy that works, especially for people on limited budgets.


 


These strategies may sound simplistic to some of you, but they are not. And they are all part of “prevention” and a culture of health.


 


Think about your community, and whether or not you have parks, bicycle paths, or places to walk safely. 


 


You are fortunate if you do, because many people don’t have access to these amenities.  Too many people live in communities where they don’t even have access to a grocery store, and many of those same people live in places where they don’t feel safe walking outside their door.  This is, unfortunately, a reality in this country.  It doesn’t have to be this way nor should it be.


 


Prevention in its encompassing form is the one thing we can do to get this mess under control. 


 


Making communities safer and healthier, reversing our love affair with watching ourselves get larger and larger, getting screened for cancer and other diseases, getting treated for blood pressure and cholesterol (and taking our medicines) as well as stopping smoking among other things is the  commitment we can make to ourselves, our children and future generations.


 


The reality is that if we don’t take care of prevention, there won’t be enough money in the world to take care of us.  It is just that simple.


 


Prevention is a key part of health care reform.  Let’s keep it that way.


 

2 thoughts on “Keep Prevention In Health Care Reform

  1. I recently returned from a trip to Denmark and Norway. What amazed us, what that you see the roads and sidewalks with bicycles everywhere. Parked by the stations etc. In the motel, there were many Europeans, including Danish and you rarely saw a “fat” Dane, they were all thin and they all had great appetites.

    In Norway it was the same. My relations my same age are all thin and they cycle. There in Norway you have the Fjords, Mountains, slopes and they cycle to work. They eat healthy and the air and water are pure. Absolutely no pollution.

    Some of the relations are in their 80-90’s and very sprite and healthy and mentally “with it”. It is all a matter of “lifestyle”, but it is also how we are brought up.

  2. Prevention should be front and center in the health care reform and watching the town hall meetings, its obviously not relevant. I’m listening to citizens voicing their opinions, struggling to stand up in front of a microphone because they are grossly obese and spewing words like Socialism, God/religion and getting rid of illegal immigrants. I’m sorry but I can’t help but express anger because of my artery-clogged, fellow Americans, I am paying thru the nose for my insurance premiums. You are correct, Dr., that getting a smoker to pick up carrot stick instead or getting parents to give their kids a piece of fruit instead of a chocolate covered donut is difficult. Key here is education which should be mandatory in schools. Stop cutting programs in schools like phys ed. Fat kids grow up to be obese adults.

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