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Durkin: ‘Primary Prevention’ Two Important Words for Policymakers

Just two words: primary prevention. They aren’t heard much in the ongoing health care debate. They haven’t caught on as political buzz words on Capitol Hill. They didn’t find their way among the utterances that grabbed our attention during the 112th Congress. But they are the very foundation on which a revitalized U.S. health care system must be built.

Not to be confused with health screenings and early diagnosis — which do matter in the effective treatment of many illnesses — primary prevention encompasses healthy lifestyle practices that deter diseases before they start. This is where we save lives, improve quality of life and avoid preventable health care spending.

Primary prevention includes healthy behaviors such as regular exercise, sound nutrition, and avoidance of tobacco and other controlled substances, along with routine stress management. We know it works.

Yet, all the fiscal fighting over health care spending and return on investment in the near-term almost entirely misses the concept of primary prevention, which inherently brings longer-term benefits. Economists deliberate over whether certain cancer screenings save or cost our health care system money within a one-, five- or 10-year window. But few seem to recognize a vital tenet for solving our medical spending problem: Health care doesn’t start in the doctor’s office.

True health care starts in America’s homes, in our schools, in our communities, in our workplaces, in our state legislatures, on Pennsylvania Avenue and on Capitol Hill. And it isn’t just about health insurance and how to pay for clinical care.

Rather, true health care is a continuum that moves with us through life. It’s highly affected by media, marketing and advertising; influenced by local infrastructures, transportation systems and housing; shaped by technology and education; subject to food costs and availabilities; altered by sedentary jobs and pastimes; and dictated by American culture.

Conversely, how we — as a nation — choose to address our current health care crisis will not simply affect dollars spent within our health care delivery system. It will affect businesses and worker productivity; innovation and economic competitiveness; military readiness; our standing in the world; the potential of generations to come; and the endurance of the American dream.

Today, as one recent report illuminates, Americans are dying at younger ages than people in almost all other high-income countries. Not only are we at or near the bottom of the heap when it comes to obesity, diabetes and heart disease, but we also have a long-standing pattern of poorer health throughout our lifetimes. And it has been getting worse for three decades.

Now swallow this hard truth: We can’t fix this health disadvantage until America adopts a culture of wellness and stops analyzing our health care delivery system in a vacuum.

Thankfully, there are a number of groups and thought leaders already on the path to revitalization. And they’re encouraging decision-makers from all sectors of society to join them.

Just this past month, the Trust for America’s Health issued a report, “A Healthier America 2013.” It proposes carefully thought-out strategies for moving America from sick care to health care in the next four years.

Noteworthy is its panoramic worldview of health care — that is, that preventive care can, and should, be provided in places outside the clinical setting. The report points out as an example community-based smoking-cessation support groups and diabetes prevention programs that help promote physical activity and good nutrition. And it calls on public health officials to work with other sectors — such as education, transportation and housing — to capitalize on the many opportunities to promote health and wellness where Americans live, learn, work and play.

Sen. Tom Harkin, D-Iowa, a longtime advocate of healthy lifestyles, recently introduced a bill calling for the very cultural shift toward wellness and prevention that America so desperately needs. While the Healthy Lifestyles and Prevention America Act (HeLP America Act) is extensive and will likely be difficult to move forward in its entirety, the spirit of the legislation is on target.

In fact, there are a number of must-pass elements of the bill that directly address the need for increased physical activity in our society — a linchpin of primary prevention. For example, one component of the bill calls for indicators describing the physical activity environment in schools (e.g., time, quality, teachers and facilities devoted to physical education) to be included in annual state report cards. It also adds PE to the existing set of core subjects, according to the Harkin press release.

Another worthwhile bill component allows employers to deduct the cost of athletic facility memberships for their employees and exempt this benefit as taxable income for these workers. Still another provides tax credits to businesses that offer comprehensive workplace wellness programs to help their employees improve their health and well-being.

Others are recognizing the value of primary prevention. In fact, Kaiser Permanente, one of America’s leading health care delivery entities, has created an electronic Exercise Vital Sign initiative that systematically records patients’ physical activity in their electronic health records. Not only will this help improve treatment and guide providers in counseling patients on healthy lifestyle practices, but it also opens a window for examining the relationship between exercise, chronic disease and health care consumption and cost.

It’s time for policymakers to expand their vocabulary. If we are to stop the tide of chronic diseases that are eroding our health care budgets and economy, then we need to widen the lens and take a long-term view. Fixation on short-term ROI in the doctor’s office isn’t going to fix the problem. We need health policies and legislation that support primary prevention and healthy lifestyle choices because we need to change the way America lives and functions.

Primary prevention. It’s a catchy little term. I urge all policymakers to learn it, practice it and promote it. It’s the very best shot we’ve got.

Helen Durkin is the executive vice president of public policy for the International Health, Racquet and Sportsclub Association.

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