Prevention: Goetzel Responds

I could not agree more with Thomas Kottke and colleagues’observations in response to my Jan/Feb 09 paper. We have medicalizedprevention and health promotion in this country so that mostpeople believe that only doctors in clinical settings can deliverthese services. Although effective in many cases, this approachis the most expensive method of delivering prevention. If weexpand our arsenal of potential interventions to include environmental,ecological, and policy changes, in addition to individuallyfocused counseling and coaching programs, we can change thecost-effectiveness equation. Health promotion programs neednot be confined to medical settings—they can and shouldalso be delivered in schools, homes, neighborhoods, and theworkplace. The work-place, especially, presents a golden opportunityfor implementing sustainable health education and behavior changeprograms, which, when done right, can achieve behavior change,risk reduction, medical cost savings, and productivity improvement,within a relatively short time period and at a reasonable cost.

This country spends a vast amount of resources on treating peoplewith illness and injuries, many of which are caused by modifiablebehavior such as overeating, being sedentary, smoking, excessivealcohol consumption, and unsafe health practices. The rapidrise of many preventable illnesses such as diabetes, heart disease,stroke, and respiratory disorders did not occur in a vacuum.Finding new and expensive treatments for these illnesses willnot serve us well in the long run. Alternatively, finding creativeways to cost-effectively prevent disease and promote good healthneeds to be tested in real-world settings as an important componentof comparative effectiveness research. Moving money around topay for costly and debilitating disease will not solve the healthcare crisis we now face in this country. Keeping people healthyso that they can avoid expensive care needs to be an importantpart of the solution.

Ron Goetzel
Emory University, Atlanta, Georgia

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Prevention: Goetzel Responds