As you know, there's been a ton of argument about whether prevention saves money -- and one of the issues has been how narrowly we define "prevention," whether we treat it as a synonym for "screening for early detection of disease" or whether it's something bigger.
Today, a report by the Trust for America's Health (TFAH) and The New York Academy of Medicine (NYAM) comes down firmly on the side of prevention (broadly defined) as a money-saver.
The report, Compendium of Proven Community-Based Prevention Programs, is a comprehensive review of studies which document community-based disease prevention from all around the world. Specifically, the report looks at programs aimed at decreasing smoking, increasing exercise, and improving healthy eating. The goal of these programs is not just to detect disease early, but to prevent it altogether.
Community-based prevention programs work to reach out to the population as a whole, and address common health problems. These programs:
- Work to reduce rates of obesity, high blood pressure and high cholesterol, and encourage people to exercise and eat healthier, which can lower risk for cardiovascular disease, stroke, and diabetes.
- Getting people to stop smoking (or never start) can lower the risk of cardiovascular disease, and many types of cancer -- especially lung cancer.
- Asthma can be managed by proper diagnosis, care, and management, reducing the hospitalizations and absenteeism that asthma causes, particularly in school-age children.
- Community-based intervention programs to prevent the elderly from falling, which is a leading cause of injury, traumatic brain injury and death for those 65 and over.
- Programs that encourage the use of condoms and safe sex practices can lower the rates of sexually transmitted infections, including HIV.
Some of the initiatives described in the report were as simple as walking more each day, but they had a positive impact on local communities. For example,
- Researchers at Ohio State University recruited 60 women in their forties for a 12-week walking program on the college's campus. At three months, the intervention group saw a one percent decrease in body mass index (BMI), a 3.4 percent decrease in hypertension, a three percent decrease in cholesterol, and a 5.5 percent decrease in glucose levels.
- The New York State Healthy Neighborhoods Program conducted an asthma intervention in which outreach workers conducted home visits and provided education about asthma, referrals, and controls for asthma triggers. During the program's 1997-1999 funding cycle, the average hospitalization (hospital admissions and ER visits) rate decreased by 23 percent.
- A worksite intervention program targeting approximately 800 high-risk employees who smoked provided them with cardiovascular risk factor screenings, individualized counseling and related services. At 3.7 years, the intervention group realized a 12.6 percent decrease in the amount smoked, a 3.3 percent decrease in diastolic blood pressure, and a 7.8 percent decrease in cholesterol, meaning an overall reduction in their risks for developing cardiovascular disease.
On a call announcing the release of the report, leaders from the Trust for America's Health, The New York Academy of Medicine, and The California Endowment expressed concern that prevention programs are overlooked by reformers looking for savings. Trust executive director Jeff Levi, PhD, disagreed with the CBO's estimations on the amount of savings that prevention programs bring. He hopes that nonclinical prevention programs, like those examined in the report, will find a place in current health reform legislation. According to a TFAH report released in July 2008, an investment of $10 per person in community health could result in health care savings of $16.5 billion over five years.
Levi, writing in the RWJF Users Guide to the Health Reform Galaxy Blog, also pointed to what we can learn about prevention and community health from the $650 million in stimulus money being made available in the Communities Putting Prevention to Work initiative. He called it "an important down payment on the road toward real health reform that will help make Americans healthier." The initiative will make money available to 30 to 40 communities or states to "built or expand upon programs that prevent chronic disease and obesity by addressing physical activity, nutrition and tobacco use."
"At the end of the day," he wrote, "these programs will be the laboratory for showing what results we can have if we invest more heavily in wellness and prevention." Healthier, higher quality lives.