The Value of Prevention, Avoid the Games and Focus on Real, Evidenced-Based Opportunities to Improve Health, Wellbeing and Longevity

Chronic Disease Prevention

• More than 86% of the nation’s healthcare costs relate to chronic diseases, and most of those costs are preventable [9, 10].
• The projected prevalence of any cardiovascular disease in the United States will increase to over 45% by the year 2035 [11].
• Risk factors such as poor diet, lack of activity, alcohol and drug abuse, and ignoring medical advice all contribute disproportionately to this crisis [11].
• 27% of young adults are too overweight to serve in the military. Many others lack necessary fitness to meet requirements [12].
• According to the CDC, 90% of the nation’s $3.8 trillion per year healthcare costs can be attributed to people with chronic diseases and mental health conditions [1].
• A recent Partnership to Fight Chronic Disease publication determined that treatment of the seven most common chronic diseases, coupled with productivity losses, will cost the U.S. economy $2 trillion dollars annually - $8,600 per person - by 2030. The same analysis estimates that reductions in unhealthy behaviors could save 1,100,000 lives per year [1].
• In terms of public insurance, treatment of chronic disease constitutes a significant proportion of spending and improving prevention would result in significant cost savings. Preventing child obesity is a critical step for the nation and there are cost-effective interventions in childcare, schools and community. For example, improving physical activity in childcare costs only $4.60 per child per year and would avert over 74,000 cases of childhood obesity including among children on Medicaid and CHIP. In addition, increasing the colorectal cancer screening rate to 70% could reduce Medicare spending by $14 billion in 2050 [12].
• The most recent addition to these programs is a set of activities based on the Lancet Commission Recommendations regarding a body of evidence showing the opportunity to reduce risk for Alzheimer’s disease and other dementias [13].

It is long past time for us to face reality - if we don’t invest in prevention now, many of us will die sooner and suffer more on the way. We have created a culture where the healthy choice often is a harder choice at every stage of our lives. We know we need to eat better, be more active, and avoid tobacco - but we’re cutting back on recess and physical education, cutting back on the ability to be active in our everyday lives, and tobacco is still widely available, especially to children [1]. The CDC estimates that modifying three risk factors - poor diet, lack of physical activity, and smoking - can prevent 80% of heart disease and stroke, 80% of type- 2 diabetes, and 40% of cancer. Good, healthy food options are more available today - but not everywhere - and not for everyone. If we are serious about improving the lives of Americans, having an impact on healthcare costs, reforming our system, and reducing disparities, we need to invest in a meaningful way in prevention [12].

Now we are hearing proposals to further weaken the public health infrastructure by replacing the US Preventive Services Task Force [14]. This important group plays an essential role in access to free cancer screening and tests for chronic diseases. They are often the arbiter of what insurance should/ must pay for especially in public insurance programs such as Medicare and Medicaid but including many employee benefit programs and others. They have a long-standing reputation for using current, high standard science for direction and guidance that now may be at risk [14]. When layered on the significant cuts proposed in the Executive Budget for FFY 2026 (Proposed - $3,588,000,000 at CDC alone) [15], this proposed move strikes many including the American Medical Association in the field as heading in a very risky and likely deadly direction [16].

I remind us of a piece I shared in these pages a few months ago [17] “Anticipating Challenging Changes, Principles must be the Backbone of our Approach”.

Once again, we are bowled over by the combination of political divisions and headlines regarding a healthcare crisis. Workforce shortages, long waits for essential services - and even basic services, inability to access needed materials and pharmaceuticals, seemingly purposeful dissemination of mistruths and half-truths, all of which scream out for critical interventions. One of the dangers we face is getting so involved in critical individual issues and political struggles we miss the opportunity to look at real issues we need to face to make a difference on a community, population or societal level. Don’t mistake my thinking; we need to address the individual issues and each of those aspects of healthcare I mention above where we are currently challenged. My point is we need to address them based on science, facts, and a principled approach with a meaningful dialogue. When I think of these important concepts through the lens of Beauchamp and Childress [17] and look closely at the issues at hand thinking about Autonomy (informed decision making for ourselves); Beneficence (intention for good); non-maleficence (avoidance of harm); and Justice (requiring fairness for all), the issues before us have more clarity and opportunity for improvement.

When we apply this lens I mention we must also ask difficult questions about health and public health. We know that uninsured people are less healthy, more likely to incur ongoing costs (from chronic conditions), and more likely to incur significant costs for emergent care – much of which is preventable. As stated above, population-wide currently chronic conditions account for over 86% of healthcare costs, much of which is preventable [4]. Another set of critical questions comes to mind:

• Is our current system of funding healthcare (a mix of public and private “insurance”) really the best way to proceed?
• Should we find ways to offer preventive care to all to reduce the financial and human burden of preventable chronic and emergency care?
• Should we invest in raising awareness throughout the population on ways we can all improve our health and reduce risk of serious chronic conditions (including Alzheimer’s disease and mental health [13].
• Would additional access to prevention and primary care reduce chronic and emergent care needs broadly?
• If so, how can we achieve these goals while maintaining high quality standards of care?