For most of my career in medicine, the emphasis has been on treating disease. New drugs, new diagnostic tests, and new surgical approaches have improved life, delayed death, and created a culture of “if it’s broke, just fix it.”
Prevention has not been a very popular nor lucrative way to practice medicine. Until recently, Medicare did not cover many preventive services. And, commercial insurers limited prevention coverage, often at the urging of their employer customers who were footing the bill.
Now that our country and, in fact, the entire world is awash in chronic preventable diseases—such as obesity and type 2 diabetes—healthcare professionals, policy wonks, and politicians are rediscovering the joys of prevention. Better yet, they are realizing we will not be able to turn the tide on these chronic illnesses by healthcare alone. We need a strong and effective public health approach.
How public health prevention approaches can help
Cigarette smoking is a good example. Although we have known about the link between tobacco and many different diseases, such as lung cancer and heart disease, for many years, we learned relatively late that counseling and/or cajoling of smokers by health professionals is not been nearly as effective as passing laws that restrict where smokers can smoke.
I live in Northern California, a region of the country that has had smoke-free restaurants, bars, and other public places for years. It is darn hard to find a place to smoke in Northern California, so many smokers quit smoking. Now, California has one of the lowest smoking rates in the country. To illustrate how effective this type of public health approach can be, it is remarkable to read that France—France, of all places—has recently advocated banning cigarette smoking in some public places.
Can we take the lessons learned from tobacco and apply them to our latest scourge—obesity and type 2 diabetes? The answer is a resounding “yes”. And, I am pleased to report that we are starting to see some terrific work in this area.
Huckabee: A prevention hawk?
I want to start with Mike Huckabee, the Governor of Arkansas. A recent article in USA Today called Governor Huckabee a prevention hawk…I love it. Prevention hawk! I want to be a prevention hawk. I want everyone to be a prevention hawk.
As is usual when someone becomes passionate about an issue, there is a personal story. Governor Huckabee gained a lot of weight and was eventually diagnosed with type 2 diabetes. It “scared the daylights” out of him. He went on a diet and began to exercise regularly. He lost the weight and lost the diabetes, but, luckily for Arkansans, he found a passion for public health. According to the USA Today article, here are some of the things he has helped happen in his state:
- Arkansas schools are required to measure each student’s body mass index, a formula that uses height and weight to calculate whether a person is verging on obesity (38% of the kids were). Letters are sent home to parents, “who apparently took notice and tossed out the Twinkies and catapulted kids off the couch.”
According to Arkansas Surgeon General Joe Thompson as quoted in the USA Today article,
“When we looked back, it became clear that we had halted the state’s childhood obesity epidemic.”
The libertarians amongst us may balk at the State’s interference into the private lives of its citizens, but the prevention hawks, like me, say, “Yes! At last, public policy that will save lives. Way to go, Governor Huckabee and the State of Arkansas!”
The USA Today article goes on to say that:
“Huckabee also backed a health assessment for the 110,000 members of the state employee health plan, which provides coverage for stop-smoking programs, nutritional counseling, dietary assistance, even gastric bypass surgery. People who cut their health risks can earn $20 an adult a month off the cost of their family health plan.”
Public health approaches to obesity and type 2 diabetes
Public health approaches to obesity and type 2 diabetes are starting to pop up all over the country. The American Heart Association and the Clinton Foundation announced in early October that Campbell Soup Co., Dannon, Kraft Foods, Mars, and PepsiCo have all adopted nutritional guidelines for snacks sold in schools.
Communities are advocating for sidewalks so people can walk in their neighborhoods. They want grocery stores that sell produce that is really fresh so they can buy apples and lettuce instead of buying potato chips and candy bars at the local liquor store. Companies are starting to recognize the need to offer exercise opportunities for their employees. And health insurers are not only paying for prevention, they are also offering their members prevention programs. One large insurer, Kaiser Permanente, has made prevention the focal point of their advertising campaigns, with some of the best, most creative, and compelling ads for healthy lifestyles ever seen on television.
Yes, I think it is the dawning of the “Age of Prevention”. Thank heavens. But to be sure the sun continues to shine on this new approach, we, the general public, need to embrace robust public health approaches to prevention. Enough already with the “personal choice” stuff—no one really chooses to get fat and get diabetes. No one wants to die of a disease that could have been prevented.
So, I say, let’s all strive to be labeled in the way that USA Today labeled Governor Huckabee. Let’s all become prevention hawks. Let’s demand public health that protects the public from preventable disease.
I will go on the record now and say, “I am a prevention hawk and I am proud of it.”