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Health Affairs, 28, no. 1 (2009):
36
doi: 10.1377/hlthaff.28.1.36 © 2009 by Project HOPE |
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Preventing Illness |
PROLOGUE
Preventing Chronic Illness
A core truth about chronic conditions is that most are preventable. As Susan Brink’s Report from the Field recounts, the multiyear trial known as the Diabetes Prevention Program (DPP) demonstrated that lifestyle modifications alone could produce sharp reductions in the development of diabetes in high-risk people with prediabetic conditions. Moreover, a few key strategies—such as improved diet, exercise, and weight loss, along with smoking cessation—can simultaneously reduce the risk of several conditions such as cardiovascular disease and cancers. So it’s no surprise that policymakers say that prevention should assume a far more prominent role in U.S. health care.
But should prevention be understood as a strategy to save money, or rather as an investment that—like many health interventions—costs money yet produces better health? Louise Russell examines the medical costs associated with preventive programs, along with the additional healthy days of life they produce. By this metric, most preventive interventions—including the DPP lifestyle modification—cost more than they save. In strict financial terms, the unfortunate calculus frequently is that a pound of cure (or treatment) costs less than an ounce of prevention.
Although that may be true, Ron Goetzel warns policymakers not to dwell on this tightly focused financial calculus alone. Preventive measures, while not cost-saving, can be cost-effective—although some more so than others. Some important preventive strategies, like raising taxes on cigarettes, don’t require big outlays, and costly ones can be made less so through innovation. In fact, studies are testing how well the main components of the DPP lifestyle intervention can work when delivered in a less costly setting—at a YMCA, for example.
Goetzel along with Jon Gabel and colleagues show us that these points are not lost on the employers that sponsor health promotion programs. It may not be clear at this point which preventive interventions aimed at chronic conditions will yield the greatest benefits. But as the nation embarks on discussions about investing more heavily in prevention, these papers argue that it’s critical to bring realistic expectations and clearly defined goals to the table.
Related Articles
- Ron Z. Goetzel
Do Prevention Or Treatment Services Save Money? The Wrong Debate
Health Affairs, January/February 2009; 28(1): 37-41.
[Abstract] [Full Text] [PDF]
- Louise B. Russell
Preventing Chronic Disease: An Important Investment, But Don’t Count On Cost Savings
Health Affairs, January/February 2009; 28(1): 42-45.
[Abstract] [Full Text] [Figures Only] [PDF]
- Jon R. Gabel, Heidi Whitmore, Jeremy Pickreign, Christine C. Ferguson, Anjali Jain, Shova KC, and Hilary Scherer
Obesity And The Workplace: Current Programs And Attitudes Among Employers And Employees
Health Affairs, January/February 2009; 28(1): 46-56.
[Abstract] [Full Text] [Figures Only] [PDF] [Appendix Exhibits]
- Susan Brink
The Diabetes Prevention Program: How The Participants Did It
Health Affairs, January/February 2009; 28(1): 57-62.
[Extract] [Full Text] [PDF]
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