Small Disease Prevention Steps Would Result in Big Gains, Study Says

The United States could save more than $16 billion a year within the next five years by making small but strategic investments in disease prevention, according to a new study (72-page PDF; About PDFs) released by the Trust for America's Health, or TFAH.

According to the study, an investment of only $10 per person, per year in community-based interventions designed to increase physical activity, improve nutrition and prevent smoking could result in savings of more than $16 billion annually within the next five years. Furthermore, said the study, this savings -- a return of $5.60 on every $1 spent -- does not include gains achieved in worker productivity, reduced absenteeism at work and school, and enhanced quality of life.

Of the $16 billion in savings, Medicare could save more than $5 billion, Medicaid more than $1.9 billion and private payers more than $9 billion, according to "Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities."

"We are often focused on major change," said Rich Hamburg, director of government relations for TFAH, in an interview with AAFP News Now. "But there is a growing body of evidence showing that even small changes can make a significant difference."

Losing eight to 10 pounds, for example, could prevent many patients from progressing from prediabetes to diabetes, resulting in significant savings to the health care system, said Hamburg. "It doesn’t have to be massive weight loss or running 15 miles a week," he noted. "It means doing some small things and removing some barriers that will move us forward."

The report's findings are based on an economic model developed by researchers at the Urban Institute and a review of evidence-based studies conducted by the New York Academy of Medicine. It also relies on strategic low-cost, community-based primary and secondary prevention efforts that are known to either reduce disease rates or improve health choices but that do not involve direct medical care.

Three key factors have a direct bearing on the population's health, according to the study. These are physical activity, nutrition and smoking. Two-thirds of Americans are overweight or obese, one in five do not engage in physical activity, and one in five smoke, notes the report, but these conditions and behaviors can be modified relatively inexpensively.

Various prevention strategies, including enhanced access to affordable nutritious foods, increasing the number of community parks and sidewalks, and raising tobacco taxes to discourage smoking, can target specific communities or at-risk segments of communities, says the report.

These prevention strategies could reduce rates of type 2 diabetes and high blood pressure by 5 percent within five years, while leading to similar reductions in the incidence of heart and kidney disease and stroke within the same amount of time. Prevention strategies also could reduce some forms of cancer, arthritis and chronic obstructive pulmonary disease by 2.5 percent within 10 to 20 years, notes the report.

Hamburg stressed that prevention efforts will vary based on the circumstances of individual communities. In some school districts, for example, prevention efforts may entail removing less-than-healthy foods from school vending machines or keeping school gyms open later to allow students to exercise. In another area, prevention may include providing incentives in the food-stamp program to promote the purchase of healthier foods.

One of the keys is to make sure prevention efforts are conducted on a community-wide basis, not in a piece-meal fashion, said Hamburg. In addition, all stakeholders should be involved. "It is difficult to tell someone in a high-crime area to go out and go for a walk," said Hamburg. That's why local police and fire department officials may have to be involved -- to resolve safety issues by making the streets safer, he added.