During the 20th century, America’s commitment to preventive health efforts such as water purification and vaccinations all but eradicated many deadly illnesses and, in the process, extended the average life expectancy by three decades, from 47 years in 1900 to 77 in 1999.
The historic success of public health initiatives invites an obvious question. Why in the 21st century do we accept a “sick-care” system that drains our treasure after disease strikes while giving prevention the short shrift?
Although the reasons for their increased prevalence are complex and differ from community to community, one thing is clear: our current strategy of focusing primarily on treatment rather than prevention isn’t working and the toll in economic costs and human suffering are untenable.
Chronic disease, compounded by a 40 percent adult obesity rate, is the leading cause of death in the U.S., costing more than $3.7 trillion a year in medical expenses and lost productivity. Deaths from drug overdose, fueled by cheap opioids, rose fourfold to more than 70,000 from 1999 to 2017, according to the Centers for Disease Control. Suicides rose 61 percent to more than 47,000 over the same period.
Reversing these trends will require investment in strategies that include incentives for healthier lifestyles, better access to screenings for chronic diseases and a more flexible regulatory structure that encourages innovation. Although the federal government should play a role, the focus should be at the state and local levels.
The quality of our health is determined primarily by local influences such as income, crime, diet, culture and physical environment. As Quartz demonstrated in a recent article, life expectancy in the U.S. varies widely from one zip code to another. The national average in 2017 may have been 78.6 years, but in neighboring zip codes the typical lifespan varied by as many as 20 years.
Just as wellness and life expectancy vary, experience suggests that prevention-focused initiatives tailored to local circumstances are the most effective.
For example, over the past three years, the Federal Drug Enforcement Administration has quietly allied itself with churches, hospitals, health insurers and community organizations to fight opioid addiction in about a dozen cities. The DEA 360 program unites these stakeholders to create education, peer-to-peer counseling and treatment solutions to fit local needs. The DEA hasn't stopped enforcing the law but recognizes that enforcement alone isn’t enough.
Better nutrition is another simple, low-cost remedy for many chronic diseases. In Pennsylvania, Geisinger Health Systems is experimenting with “food pharmacies” where diabetes patients get fresh, nutritious food in addition to medicines.
Participants also receive 20 hours of classes on diabetes and nutrition. Nearly 250 patients have lowered their blood-sugar levels and, in some cases, have been able to reduce or eliminate medications. Insurer John Hancock’s Vitality program offers reduced premiums and discounts on purchases of selected food items and fitness and recreational items.
The Cities Changing Diabetes program explores new ways of detecting diabetes and caring for patients at the community level. The city of Houston provides a perfect example of how to adapt broad strategies to meet local needs. Recognizing the influence of faith communities, health officials teamed with clergy and diabetes experts to develop the Faith and Diabetes Initiative. The program utilizes places of worship to teach diabetes prevention, detection and management among the most vulnerable populations.
Of course, we will continue searching for new treatments to cure disease, but at the same time we must orchestrate a revival of preventive health. That will require a fresh take on aligning the financial incentives that led to our sick-care system. It also requires viewing conditions like obesity and substance-use disorders not as moral failings, but preventable and treatable diseases.
Until we embrace these tools, our health outcomes will not improve and the promise of new products and treatments will remain unrealized. As the search for breakthrough technologies and medicines continues, the public and private sectors should simultaneously invest in a healthcare infrastructure that makes prevention a priority.
Ed Greissing is the executive director of the Milken Institute’s Center for Public Health in Washington, D.C.