In defense of prevention, and the prevention fund

Three years ago, when the Affordable Care Act was passed, the bill set up something that was unusually far-thinking by Washington standards: an ongoing funding source dedicated to preventing illness before it occurs.

For me, the creation of the Prevention and Public Health Fund was an affirmation of the work I’ve been doing for three decades to curb the use of tobacco and prevent illness and injury before it occurs, and elevate the idea that all communities can and should be healthy places. Fifteen years ago, I founded Prevention Institute in Oakland, Calif., to help communities across the country pursue this work.

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The idea of the prevention fund was to make an ongoing investment in our nation’s future by providing support for efforts proven to reduce diabetes, hypertension, heart disease and other conditions. The goal was simple: stem rising rates of preventable chronic disease, which is sapping the health of the American people and the treasure of business and government. The investment was to be modest: rising to about $6.39 per year for every person in the U.S.

But sensible as it is, prevention hasn’t proven a popular notion in Washington. Since its creation in 2010, the prevention fund has been pitted against student loans, insurance coverage for high-risk patients and payments for Medicare doctors. Last year, wrangling over the budget wiped out 40 percent of the fund before it had completed its second year.

Last month, Health and Human Services Secretary Kathleen Sebelius announced that $332 million will be taken from the fund this year to help pay the cost of enrolling people in new healthcare exchanges. Next year, she wants $54 million to be spent on “health navigators” to help people enroll. Not to be outdone, House Republican leaders plan to offer a bill that would take $3.6 billion from the fund to extend short-term coverage for people with preexisting conditions until they gain insurance next year through provisions of ObamaCare. And they also plan yet another attempt to repeal the entire Affordable Care Act in a vote this week.

It’s open season on the prevention fund — and business as usual for Washington. I believe the debate over the fund is premised on a false choice: that Americans must choose between caring for the sick and preventing chronic illness. This is wrong on every count.

The U.S. spends about $2.7 trillion a year on healthcare, and three-quarters of that is spent treating chronic conditions such as heart disease, stroke, diabetes and cancer, according to the Centers for Disease Control and Prevention. We know these conditions are often preventable. About 40 percent of premature deaths are linked to smoking, poor diet, lack of physical activity and other unhealthy behaviors, according to the Institute of Medicine.

But we can change this picture. Over the past three years, grants from the prevention fund and other sources have helped cities across the country take important steps to improve the health of their residents. Nashville, a city with one of the highest rates of diabetes in the country, created bike-friendly greenways and running paths and pulled high-fat junk food from school vending machines. San Antonio set up salad bars in school cafeterias and exercise equipment in parks. Hernando, Miss., added walking trails and playgrounds, built a community garden and started a weekly farmers market.

“My job,” said Hernando Mayor Chip Johnson, “is to create an atmosphere and an opportunity for good health.”

Johnson, a Republican and small-business owner, understands why this is important. He told our colleagues at Trust for America’s Health that his state will spend almost $1 billion this year on healthcare costs related to obesity, an amount that could quadruple by 2018. “We need to deal with this,” he said. “It’s a dollar and cents issue.”

Too many of our leaders in Washington seem not to get this. One who does is Iowa Sen. Tom Harkin, a great champion of prevention who sadly is retiring at the end of next year. Harkin is not at all happy with the Obama administration’s most recent raid on the prevention fund, and he showed his displeasure by putting a hold on the administration’s nominee to head the Medicare and Medicaid program.

“The prevention fund works,” Harkin said at a recent Senate hearing. “Thanks to this funding, more children are being immunized. More people are quitting smoking. More communities are fighting chronic disease.”

“We have failed miserably,” Harkin added, “by failing to focus on prevention. Like clueless dodos, we wonder why healthcare is going through the roof.”

Thanks, Sen. Harkin. I couldn’t have said it better myself.

Cohen is the founder and executive director of Prevention Institute in Oakland, Calif.