Preventive Healthcare Initiatives and the Knowledge Gap

A number of diseases and conditions can be prevented through early intervention and screenings. “Following your doctor’s preventive health advice can make all the difference in your health,” the Henry Ford Health System advises.

The reason why is simple: It is far easier and less expensive to prevent an illness than treat or manage it. And catching some illnesses early, like cancer and heart disease, can mean the difference between life and death.

Reducing or eliminating risk factors for common chronic conditions is important. Those include smoking, obesity, high blood pressure and high blood sugar, and preventive medicine can reduce or eliminate them. Screening tests, such as mammograms, colonoscopies and full-body skin exams, are another preventive tool that can help identify if someone is at risk for developing a condition or disease.

Not sure why you should care? Consider this: Chronic diseases, like heart disease or diabetes, are responsible for 7 out of 10 American deaths every year and account for 75 percent of the country’s health spending. Preventative measures such as eating health and exercising regularly, combined with health screenings, can make a big difference.

Despite the benefits of preventative care, the Centers for Disease Control and Prevention (CDC) estimates that Americans use such services at about half the recommended rate.

This trend is even more curious because Americans can access preventive services without cost-sharing fees like deductibles, copayment or co-insurance under the Affordable Care Act (ACA, commonly known as Obamacare). Such fee-free services include diabetes, cholesterol and blood pressure screening.

A 2015 study looked at the impact the ACA fee-free requirement had on preventive care services at Humana, a large national health insurance company. Curiously, researchers found no significant change “in the level or slope of colonoscopy and mammography utilization for intervention plans relative to the control plans.” In other words, people weren’t getting colonoscopies and mammograms despite the ACA requirement that they be free.

How can we get more people to access preventive services?

The fact that many Americans are still not using preventive services means they need to be educated about the importance of prevention.

 

A number of organizations, including governmental ones, are looking to spread the word about preventive care. One is the National Prevention Strategy, which the CDC describes as a “comprehensive plan that will help increase the number of Americans who are healthy at every stage of life.”

Called for by the ACA, the plan was created by the National Prevention Council. Also an ACA requirement, the council is made up of the heads of 17 federal agencies and is chaired by the Surgeon General.

What the strategy recognizes is that good health is about more than receiving quality medical care; it is about preventing disease. It focuses on seven priority areas: tobacco-free living, substance abuse prevention, healthy eating, active living, injury- and violence-free living, reproductive and sexual health, and mental and emotional well-being. 

The Watts Health Center in Los Angeles also developed a Preventive Health Services Program to improve patients’ health. The program is made up of a number of components, including educating residents and businesses about the dangers of smoking. People are encouraged to called the number 1-800-NO-BUTTS to help them quit. The staff at Watts works with community organizations and helps them develop and implement smoke-free policies. Individual and group counseling is provided for people who want to quit smoking.

In another best-practice example, the Fresno County Department of Public Health (DPH) works on a number of initiatives to both educate people about prevention and reduce risk factors for disease.

The DPH doesn't execute these initiatives on its own, but partners with other organizations to truly move the needle on public health. “These issues are quite large and daunting, and no single organization can be successful by themselves,” Sara Bosse, manager of the Fresno County DPH Office of Policy, Planning and Communication, told Triple Pundit.

One of its flagship initiatives is a diabetes collaborative called Fresno Diabetes, which is part of the Fresno Community Health Improvement Partnership (FCHIP). The group set up a website to give Fresno County residents information about diabetes and prevention of the disease. County residents can take a type 2 diabetes risk quiz.

“Prevention is really important,” Bosse said. “There are a lot of chronic diseases people suffer from. There are a lot of risk factors. There are behaviors such as diet, exercise and smoking that contribute to the risks for developing chronic diseases.”

Lack of access to fresh fruits and vegetables is a big risk factor for developing certain diseases such as heart disease and diabetes. And low-income people living in food deserts often do not have access to fresh fruits and vegetables.

 

The U.S. Department of Agriculture (USDA) defines a food desert as parts of the country that lack access to “fresh fruit, vegetables, and other healthful whole foods, usually found in impoverished areas.” Many food deserts exist in Fresno County, and the DPH has several initiatives to address the problem.

It partners with Fresno Metro Ministry on a program called Food to Share. Food that would go into landfill but is still edible is collected from a variety of places including farmers markets, foodservice facilities, restaurants, supermarkets, and growers and packers. Organizations and ministries then distribute the collected food to underserved communities within Fresno County at no cost.

The San Joaquin Valley, where Fresno County is located, is considered by many to be the agriculture center of the world. It supplies a good deal of the fruits and vegetables Americans eat. But some residents of the Valley, including in Fresno County, can’t access what is grown in their virtual backyards. So, as part of its work, the DPH also works "with partners to increase distribution sites for CSA (community supported agriculture) boxes,” Bosse said.

For those who aren't familiar, a CSA is a pre-made box of produce that is delivered from a local farm to a distribution site or a person's front door. They are typically available in high-income neighborhoods. “What we have done, and we are just getting started with, is expanding CSA availability to lower-income neighborhoods,” such as church and school sites, Bosse said. The department also works with CSAs to offer the use of EBTs (electronic benefit transfer, commonly known as food stamps) to pay for the boxes.

The bottom line is: It's time for Americans to take greater responsibility for their own health. With low-cost preventative care available through ACA, and a growing number of local organizations looking to boost wellness across the country, we really have no excuse.