Prevention in America

The definition of the word prevention is "an action or actions taken to prevent someting from taking place."

In the world of health, prevention evaluates an individual’s health status — and is at the heart of early detection. Unfortunately, health is not a priority in this country. Look at the money spent by the National Cancer Institute on cancer prevention and you see the value placed on prevention in healthcare. Prevention is not a moneymaker. However, if one can place value on human life, prevention becomes the most profitable aspect of health. Prevention saves lives.

The National Commission of Prevention Priorities (NCPP), an initiative of the Partnership for Prevention, released a report last July titled “Preventive Care: A National Profile on Use, Disparities, and Health Benefits.” The report basically says we are looking at the canaries in the coal mine as the tunnel fills with deadly gas. America’s demographics are rapidly changing, and minorities and the underserved are the canaries in this case. As these people die, everyone else is not far behind.

Our nation’s healthcare has changed from a model that focuses on infectious disease to one of chronic disease. This is important because in an infectious disease model, prevention is critical. Your health is as important to me as it is to you because if you get sick, I could catch what you have and also be sick.

In a chronic disease model, simply stated, your health is your problem. But is it? If these populations do not use preventive opportunities, what will happen to the healthcare system when they begin to suffer more and more from chronic disease? For instance, there is a shortage in qualified mammography units and personnel to read the mammograms. Think what will happen in our system when so many of the women who go unscreened develop breast cancer.

One report finding says that “many Americans, particularly minorities, have no continuity in their healthcare, no relationship with a doctor or other medical professional who can ensure that they are getting all the preventive care they need.”

The NCPP states that African Americans, Hispanic Americans and Asian Americans are at major risk for a number of preventable diseases because they are using preventive services at a lower rate when compared with the white, non-Hispanic American population. For instance, Hispanic Americans have a lower utilization rate for 10 of the 11 preventive services analyzed in the report when compared with non-Hispanic whites and African Americans. Asian Americans have the lowest utilization of any group for compliance with the recommendation that those at risk for heart disease take one aspirin a day. In addition, Asian Americans have the lowest utilization of breast, cervical and colorectal cancer screening.

If we were to increase the colorectal screening among African Americans age 50 and older from the current utilization rate of 42 percent to 90 percent, we would save an additional 1,800 lives annually. This gets back to the value of human life.

It is clear that prevention saves lives. The NCPP stated that if we were to increase the utilization of just five preventive services to 90 percent, we would save approximately 127,000 lives annually. Just the increased use of aspirin alone to a rate of 90 percent would save 45,000 lives annually.

As the burden increases on an unequal healthcare system, the impact will affect the health of all Americans in terms of availability of care. It will not be whether you have money or insurance, it will be about availability.

So what are the answers that will begin to turn the tide? Let me point to two simple words in the reauthorization legislation for Medicare and Medicaid — two words. Right now, throughout the acts, the text refers to diagnosis and treatment. Why not add to these words “and prevention.”

Lovell Jones, PhD, director of the Center for Research on Minority Health at the University of Texas M.D. Anderson Cancer Center and co-founder of the Intercultural Cancer Council, is a member of the Heal advisory board.