Abstract

To the great frustration of public health practitioners and healthcare providers alike, preventable chronic conditions and risk factors are a growing problem in the US, and policymakers are actively discussing reduction of support for evidence-based strategies shown to reduce risk for these conditions and related risks.
Despite some reduction in demand on health systems with a lessening of the Covid-19 pandemic, we continue to read of long waits for appointments for primary and specialty care, and as we’ve pointed out in previous Commentaries, our definitions of “Urgent” and “Emergency” bear scrutiny. Workforce shortages remain an issue across jurisdictions and other functional challenges remain including delays and closing programs, services and floors while demand for services and beds increases, shortages of supplies and medications, and continued presence of risk factors (i.e. tobacco and related products, unhealthy foods, community challenges to regular physical activity) and growing use of delay and reduction tactics such as “prior approval” requirements. These are important, but an incomplete picture without addressing the proven opportunities for prevention of chronic conditions and risk factors that lead to these troubling phenomena. The evidence is clear and growing that gains from preventing overweight and obesity, reducing stress on our bodies through better diet and more activity, better outcomes through earlier screening for diabetes, heart disease, dementia, common cancers and other public health strategies, we see clearly that investing in these efforts on a national basis must be part of the solution. Further, these challenges must be addressed in a way that levels the playing field so people now subject to disparate conditions have equitable access. Unfortunately, since the last time I addressed these issues, we need to add the concern of access to healthcare. Recent policy changes at the national level have us pointing that metric in the wrong direction compared to our allies and competition around the world.