Health Care Reform: Seizing the Opportunity to Prevent Illness and Injury

Good health is a cornerstone for a thriving California. Efforts to reform the health care system and ensure that all Californians have access to affordable, high caliber, and culturally and linguistically competent health care are one valuable step for improving the health of California residents.  At the same time, to ensure that access for all Californians doesn’t overload our health care system, we must simultaneously take action to prevent illness and injury in the first place.  Lack of quality health care accounts for 10 to 15% of premature deaths per year. An additional 40% of annual premature deaths could be prevented through initiatives to alter environmental conditions, social inequities, and behavioral choices.1 Yet, of the more than $1.7 trillion in health care spent every year in the United States, less than 4 cents of every health care dollar is spent on prevention and public health.2   A reform plan emphasizing comprehensive health care coverage and quality primary prevention will have the greatest impact on health status and quality of life.

Making preventing illness and injury a centerpiece of health care reform is a good investment. The potential savings in health care dollars is well worth the investment as a number of studies have shown.  For example:

• Between 1990 and 1998 the California Tobacco Control Program saved an estimated $8.4 billion in overall smoking-caused costs and more than $3 billion in smoking-caused health care costs.3

• Increasing the percentage of breastfeeding mothers to the Surgeon General’s recommended level would save a minimum of $3.2 billion annually in the United States. Breastfeeding reduces health care costs in the first 6 months of life by at least 10%.4

• Reducing average American fat intake by 3% could result in medical-cost savings of up to $12.7 billion.5

• In the first five years after California passed a motorcycle helmet law, $48 million dollars was saved in direct medical costs alone.6

Most of the health problems that plague California residents today, such as diabetes, heart disease, cancer, stroke, and asthma, can be prevented through fostering communities that support healthy behaviors and eliminate exposure to environmental hazards. The most powerful tools for shifting behavioral choices are regulatory measures and investments to change organizational and community environments. Many factors such as the price and availability of healthy food, the safety of streets for walking and children’s play, the distance people must commute to work, the presence of parks and open space, and air quality have an impact on the health of community residents. Priority must be placed on enhancing environments in communities of color and low-income communities where residents face the greatest burden of disease.

Prevention Institute joins the Strategic Alliance for Healthy Food and Activity Environments and the Having Our Say Coalition in recommending the following strategies as important steps to prevent illness and injury in California:

Support community health

Adopt regulatory measures and establish funding appropriations to support communities, especially communities of color and low-income communities, in conducting health impact assessments and initiatives to improve community environments, such as:

• Supporting healthy food retail in underserved areas

• Ensuring full and equitable access to parks, open space, and public facilities

• Adopting and implementing “complete streets” policies

• Supporting local government in utilizing planning and zoning decisions to improve health outcomes

• Developing infrastructure for distributing fresh local farm products to schools, health care, and other facilities

• Improving the nutritional quality of meals and snacks in child-care/pre-school, school and after school programs
• Providing physical education and physical activity programming for children and adults

• Eliminating the proliferation of marketing and advertising of unhealthy foods and lifestyles to children

Promote healthy worksites

Adopt model standards for government worksites and provide incentives to businesses to support employee health by:

• Offering affordable, healthy foods and beverages in vending machines and cafeterias

• Encouraging daily physical activity breaks

• Providing breastfeeding accommodation

• Providing wellness benefits and other incentives for employees to engage in healthy eating, regular physical activity, and other healthy behaviors

• Featuring clean, well-lit stairs, walking paths, or other locations for physical activity

• Offering incentives for employees to bicycle or take public transit to work

Provide preventive care and chronic disease management services that are comprehensive, affordable, accessible, and timely.

Comprehensive health care coverage should include:

• Routine assessment of dietary and physical activity behaviors

• Behavioral counseling and education

• Breastfeeding support

• Referrals and access to physical activity programs

• Elimination of marketing of infant formula from hospitals and medical offices

For more information, contact Leslie Mikkelsen, Managing Director, Prevention Institute at (510) 444-7738.

________________________________________________________________________

1. McGinnis JM, Williams-Russ P, Knickman JR. The Case for More Active Policy Attention to Health Promotion. Health Affairs, Volume 21, Number 2, p. 78 to 93, 2002.

2. Jeanne M. Lambrew, (April 2007). A Wellness Trust to Prioritize Disease Prevention. The Hamilton Project, Brookings Institution. http://www3.brookings.edu/views/papers/200704lambrew.pdf

3. http://www.dhs.ca.gov/tobacco

4. Weimer J, USDA, The Economic Benefits of Breastfeeding, Food Assistance and Nutrition Research Report No. 13, viewed at http://www.breastfeedingtaskforla.org/econ-review-bf2002.pdf.

5. Oster G, Thompson D. Estimated effects of reducing dietary saturated fat intake on the incidence and costs of coronary heart disease in the United States, Journal of the American Dietetic Association, February 1996, Volume 96, Number 2, pages 127-131.

6. Max W, et al. Putting a lid on injury costs: the economic impact of the California motorcycle helmet law. Journal of Trauma, Infection, and Critical Care, September 1998, Volume 45, Number 3, pages 550-556.

Return to top of page

Putting Prevention at the Center of Community Well Being
www.PreventionInstitute.org