Guest Columnist: Dr. Lawrence Sands on why reforming the health care system will never work without including improvements in preventive care

Sunday, Aug. 19, 2007 | 1:15 a.m.

In August the Where I Stand column is turned over to guest writers. Today's columnist is Dr. Lawrence Sands, chief health officer of the Southern Nevada Health District.

Who knew your friends and family can make you gain weight, as suggested by a recent study published in the New England Journal of Medicine? Although the findings of this study have not been fully validated, it raises an important point.

Obesity, along with other chronic diseases, cannot singularly be characterized as an individual health problem. Chronic disease is as a much a community problem as it is a personal health problem because the factors causing our individual health to get worse are most likely the same factors causing the health of our families, friends and co-workers to get worse, too.

This is an especially important point to consider as the national debate on health care reform continues to focus primarily on access to affordable, cost effective and quality medical care. Although these are certainly essential components to solving our nation's health challenges, they are only part of the solution.

Recently the National Governors Association released its position on health care reform. One of the principles identified by the association as key to comprehensive and meaningful reform is of major significance: "Efforts to improve access to health care coverage cannot succeed if there are not simultaneous efforts to reduce the high cost of care and improve the quality of care. Investments in wellness, health promotion, disease management, chronic care management, and electronic health information exchange are critical in this effort."

A collective shift is needed when it comes to our approach to health care, and as a public health physician I am encouraged that our policy makers are beginning to recognize these elements as vital to a successful health care reform effort, as they represent the untapped potential of core public health activities.

Over time it will cost us much less, in terms of dollars and quality of life, to prevent illness rather than treat those who are ill, and it is time we view dedicating resources to community wide prevention activities as an investment in a healthier future for ourselves and the generations that follow.

As the prevalence of chronic disease continues to rise, researchers predict that for the first time in modern history our younger generations could have shorter and less healthy lives than their parents. This prediction is extremely discouraging to public health practitioners like me, as the majority of chronic diseases responsible for this trend can be prevented or reduced by modifications to personal behaviors.

Prevention activities are the flagship of public health programs and have long proven to be cost-effective strategies for reducing medical costs and, even more important , for improving our quality of life.

Our health care system has been characterized as taking on the role of a "disease management agency." As a society we should demand better.

Our nation's health problems will not be cured by investing only in policies intended to reengineer how medical care is financed and delivered, or that change the way people access the system. To truly reform our health care system, any such policy changes must occur in concert with investments in a solid infrastructure to support comprehensive prevention programs that cut across all sectors of our community.

When implemented, these programs will create the social and physical environments needed to support individuals and families in making healthier choices and sustaining behaviors that protect and promote their health and the health of the community.

On a personal level this means people must take responsibility to modify their own unhealthy behaviors. On a societal level these changes will occur only with our collective endorsement of policies that provide our communities with the tools to build and support these healthier environments.

It is time for us to recognize that a health care plan without public health is a contradiction in terms. So while the attention focused on our medical care system (evidenced in the recent documentary, "Sicko," and as a prime issue embraced by potential presidential candidates) is merited, the role public health must play in health care reform, and specifically in sustaining a well-functioning health care system, must not be lost.

Without a unified, holistic approach that embraces primary prevention as a core principle, our community will suffer the long-term consequences of the human and economic costs associated with chronic diseases, rising health care costs and decreased access to care.

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