As Congress and President Barack Obama wrangle over health care reform, I hope they remember one very important point: Any plan that doesn’t include prevention as a key element will not succeed.
In 2008, the United States spent nearly 17 percent of its total economy – that’s more than $2 trillion – on health care, yet 46 million Americans remain uninsured. While this is a staggering statistic, it’s important to remember, as the Robert Wood Johnson Foundation has correctly pointed out, that seeing a doctor has little to do with staying well.
In fact, preventable conditions and addictions such as obesity and smoking put millions of Americans at risk for preventable diseases such as cancer, diabetes and heart disease.
In my home state of Ohio, where I serve as director of Health, these risk factors are prevalent. Nearly one-quarter, 23.4 percent, of Ohio adults are cigarette smokers; 36.2 percent were overweight with a body mass index (BMI) between 25 and 29.9; and 26.5 percent were obese with a BMI of 30 or higher; an ideal BMI is between 18.5 and 24.9.
And on July 1, the Trust for America’s Health (TFAH) issued a report that called Ohio the 10th-fattest state in the nation with 63.6 percent of the population either overweight or obese.
In Ohio, the five leading causes of death – heart disease, cancer, stroke, chronic lower respiratory and diabetes – all have risk factors associated with preventable conditions such as tobacco use, poor nutrition, sedentary lifestyle, etc. When you add unintentional injuries to the mix, these conditions caused 68.6 percent of Ohio deaths during 2004 through 2006.
So what do we do? We focus on prevention.
In fact, an investment of $10 per person per year in proven community-based prevention programs could save the United States more than $16 billion a year within five years, TFAH said in its F as in Fat report. That’s a big return on investment - $5.60 for every $1 spent, according to TFAH.
I believe in prevention so much, I incorporated it into my private practice in the holistic model of health care. That is care with a focus on chronic disease prevention, where patients partner with their providers to maintain good health and assist in coming up with treatment options when prevention alone is not enough.
I took this message to the White House in May when I – along with leaders of some of America’s largest companies – met with Mr. Obama to discuss innovative workplace practices designed to lessen the cost of providing health care to employees.
Simply stated, we must move from a “sick care” system to a true health care system. Today, the United States spends close to $100 billion – with Ohio spending about $3.3 billion; yes, with a ‘b,’ – to address the health consequences of insufficient physical activity and poor nutrition each year. Meanwhile, overweight- and obesity-related conditions accounted for 9.1 percent of U.S medical expenditures in 1998, according to the Journal of the American Medical Association.
Many of these overweight- and obesity-related conditions can be prevented or at least well-managed by targeting their major causes – poor nutrition and a lack of physical activity. There are no quick fixes, but if we work together to improve food choices in our schools and communities; to make communities more convenient for walking and bike riding; to make employee wellness a goal for all employers; and to stress to our children the importance of playing (physical activity) and eating well, someday, we can break the cycle of our enlarging national waistline.
In Ohio, the Department of Administrative Services launched its Take Charge! Live Well! program in 2005 after learning that 44 percent of health care costs were associated with preventable conditions, while just 27 percent were related to high-risk State of Ohio employees. Until Take Charge! Live Well was established, Ohio targeted its health care programs toward disease management and improving the health of high-risk workers.
Our Office of Healthy Ohio recently issued an Obesity Prevention Plan – available at http://www.healthyohioprogram.org – and made $1.1 million in grants available to 14 local health departments to help make physical activity and good nutritional options more readily available in their respective communities.
Ohio is now doing for its workers and residents what the United States needs to do for its citizens – focusing on prevention.
Alvin D. Jackson, M.D., is director of the Ohio Department of Health.