Gaps in knowledge impede progress on health promotion and disease prevention
At the Vitality Institute launch recently (see summary here), Alan Pollard, CEO of The Vitality Group, released new data showing that unhealthy behaviors are causing Americans to age faster. The data were derived from NHANES data on risk. And used the Vitality actuarial models, based on major cohort studies of risks for chronic diseases, to calculate Vitality Ageor a risk adjusted age for the Americans.
On average, Americans are 5 years older and 25% of Americans are 8 years or older than they think. Education and income were inversely related to the size of the gap between real and Vitality Age. What is the reason for the gap?
There are several reasons raised by speakers at the launch and echoed in recent reports:
- Ali Mokdad, using the latest burden of disease estimates showed that known risks like tobacco, unhealthy diets, physical inactivity and alcohol use are a major contributor (Institute for Health Metrics and Evaluation, 2010).
- Senator Frist highlighted the low value given to health promotion and disease prevention in decisions made about healthcare and debt reduction. This was well described in the recent BPC report he supported(Bipartisan Policy Center, 2013).
- The Institute of Medicines 2012 report on For the Publics Health clearly stated that that the failure of the health system to develop and deliver effective preventive strategies is taking a large and growing toll on nations health and economy (Board on Population Health and Public Health Practice, 2012).
- The US Chief Actuary in 2010 stated that there is no consensus in the available literature or among experts that prevention and wellness efforts results in lower health care costs (Foster, 2010).
The view of the Chief Actuary is in conflict with many recent reports showing that well designed prevention and health promotion programs can, do and have made major differences to health outcomes and are cost-effective. This is true for many community based interventions as well as for workplaces programs. The recent 2012 Annual Report to Congress of the Community Preventive Services Task Force list many interventions that apply in community settings, while 2013 reports of the World Economic Forum, the Bipartisan Policy Center and the RAND Corporation highlight which work in the workplace (Matkke, 2013).
It is true though that many interventions either do not work or not as effective as require having major sustainable impacts on the major drives of the Vitality Age gap. Well designed tobacco cessation being an example of an intervention where effectiveness has been proven but even then-quit rates in excess of 15% at 1 year are rare (Volpp, 2009). In contrast, there remains a need to have as effective weight control programs.
The RAND report provided a useful set of priority research areas requiring attention if we are to build more effective health promotion programs and the Vitality Institute is committed to start working on these with a focus on lowering major risks among working age Americans. We will report on our planning as it evolves and call about all interested to join our efforts.
Institute for Health Metrics and Evaluation. GBD 2010 Uncertainty Intervals for Causes and Risks. Web. 06 June 2013. <http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-2010-uncertainty-intervals-causes-and-risks>.
Bipartisan Policy Center. A Bipartisan Rx for Patient-Centered Care and System-Wide Cost Containment. Economic Policy Program; Health Program (2013): Apr. 2013. Web. 6 June 2013. <http://bipartisanpolicy.org/sites/default/files/BPC%20Cost%20Containment%20Report.PDF>.
Board on Population Health and Public Health Practice, Committee on Public Health Strategies to Improve Health, and Institute of Medicine of the National Academies. For the Publics Health: Investing in a Healthier Future. Washington, D.C.: National Academies, 2012.
Foster, Richard S. Estimate Financial Effects of the Patient Protection and Affordable Care Act, as Amended. Centers for Medicare & Medicaid Services (2010): Web. <http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/downloads/PPACA_2010-04-22.pdf>.
Mattke, Soeren, Hangsheng Liu, John Caloyeras, Christina Y. Huang, Kristin R. Van Busum, Dmitry Khodyakov and Victoria Shier. Workplace Wellness Programs Study: Final Report. Santa Monica, CA: RAND Corporation, 2013. http://www.rand.org/pubs/research_reports/RR254.
Volpp, Kevin G., Andrea B. Troxel, Mark V. Pauly, Henry A. Glick, Andrea Puig, David A. Asch, Robert Galvin, Jingsan Zhu, Fei Wan, Jill DeGuzman, Elizabeth Corbett, Janet Weiner, and Janet Audrain-McGovern. A Randomized, Controlled Trial of Financial Incentives for Smoking Cessation. New England Journal of Medicine 360.7 (2009): 699-709.