“Year of Ebola” Highlights Need to Invest in Preventive Health

December 5, 2014 The Hill

By Derek Yach

There’s no doubt that in health circles, 2014 will be known as the year of Ebola. The outbreak, which has sickened nearly 15,000 people and killed more than 5,000 people, highlights what can happen when basic public health infrastructure breaks down and opportunities for prevention are missed. The Ebola failure began in West Africa – but the next failure of prevention is already taking place in the United States.

Public health crises occur when we drop our guard or fail to invest in community based surveillance and basic public health infrastructure. They spread when we underinvest in public health approaches to detection and control, an ongoing problem in the U.S, as evidenced by the cutting of 50,000 American public health professionals from local and state health departments in the last few years.

It is easy to recognize that a headline-grabbing virus such as Ebola wins when prevention fails. But so do many more common killers and causes of ill health. Missed opportunities for prevention take place every day in American hospitals and doctor’s offices. Most adults who should receive vaccines never do. On average, people on chronic disease medications take their prescribed medicines less than 50 percent of the time. Smokers receive inadequate counsel to help them end their use of tobacco. People who are overweight or obese are more likely to be placed on medicines or encouraged to have surgery to tackle the side effects of excess weight then to be prescribed a personalized exercise program or diet plan. Depressed patients leave their doctor’s office depressed.

These everyday realities affect millions of Americans. And we can be certain that such missed opportunities for prevention translate over time into serious disease, disability and in some cases to premature death. The consequences of our health system’s failure to help a smoker quit, help a diabetic lose weight or help an unvaccinated person get a vaccine are serious to the individual patient and to society overall. The underinvestment in time spent by medical providers on prevention partly explains why healthcare costs in America are so high and why health outcomes are relatively low compared to other developed countries.

For years, if medical providers wanted to spend additional time with their patients on prevention, the consequence was less revenue for the provider. This perversion of incentives is slowly changing and under the Affordable Care Act, time spent on selected aspects of prevention is becoming compensable for the first time in the history of the United States. The missed opportunities in our health care system will only begin to diminish when incentives to prevent disease are better aligned, when doctors and nurses are better prepared to address the power of simple prevention measures, and when citizens demand access to effective preventive health services.

In the American health care system, the urgent always crowds out the important. Ebola wasn’t important until it became urgent and local. Preventive health efforts routinely take a back seat to the latest public health crisis. This is inefficient, ineffective and inadequate.  Policy makers and public health leaders need to demand more funding for prevention research, increase incentives for healthy activities, and embrace preventive health as a national imperative. The year of Ebola is a warning about the consequences of reactive medicine.  It is time to get our health care system out of reactionary mode and focus on the power of prevention.

Yach is executive director of the Vitality Institute, a New York City-based organization that advocates for greater preventive health measures.? He formerly served as an executive director and cabinet director at the World Health Organization, a senior vice president of global health and agriculture policy at PepsiCo?, and a professor of global health at Yale University.


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