An ounce of prevention leads to healthier lives and reduces medical costs, so it's worrisome that some of the nation's more valuable prevention programs are vulnerable to federal budget cuts, said panelists at a recent health care forum on Capitol Hill.
Amy Pisani, M.S., left, executive director of Every Child By Two, and Georges Benjamin, M.D., executive director of the American Public Health Association, discuss prevention during a panel discussion hosted by the National Coalition on Health Care.
Several public health officials discussed the issue during an Oct. 31 panel event titled "Prevention Across the Lifespan"(www.nchc.org) that was hosted by the National Coalition on Health Care. The speakers warned that proposed cuts to prevention programs being considered in Congress could leave the country vulnerable to outbreaks of disease.
Panelists called on lawmakers to maintain funding for the Prevention and Public Health Fund(www.hhs.gov) that was established by the Patient Protection and Affordable Care Act to address immunizations, diabetes prevention, injuries among the elderly and other public health initiatives.
"We have to ensure that population health and prevention is a shared value," said Georges Benjamin, M.D., executive director of the American Public Health Association. "Whether it's tuberculosis, Zika or immunizations, the money often comes a little too late and never sustains itself."
- Several public health officials discussed the importance of prevention during a panel discussion titled "Prevention Across the Lifespan" that was hosted by the National Coalition on Health Care.
- The speakers warned that cuts to prevention programs being considered in Congress could leave the country vulnerable to outbreaks of disease.
- According to the CDC, vaccination of children born between 1994 and 2016 has prevented 381 million illnesses and avoided 855,000 early deaths, and every dollar spent on childhood vaccines saves $10.
Public health campaigns need support from the federal level on down to sustain positive outcomes, but Benjamin noted that many local communities have cut back on public health initiatives after the recession.
"There is some confusion between treatment and prevention," Benjamin said. "We're not going to be able to 'treat' our way out of this."
Properly funding immunization programs would help, and the CDC recommended allocating $1 billion in federal funding for immunizations in 2018. But Congress is discussing a figure between $550 million and $600 million -- a reduction from the $606 million budgeted for 2017.
"We're doing well vaccinating young children," said Amy Pisani, M.S., executive director of Every Child By Two, an organization that advocates for immunizations. "But we'll never be at a point where we can say, 'We've got vaccinations covered' because babies are born every year."
Pisani identified areas where vaccination rates need to improve. During the past three years, 67,000 people contracted pertussis, but fewer than half of pregnant women received were vaccinated against the disease. Each year, 27,000 people are affected by HPV-associated cancers, but only 50 percent of teenagers have received the vaccine.
And although Pisani said only a small percentage of the population refuses vaccinations, many unvaccinated individuals live near each other, which increases the risk to public health. She noted that the number of measles cases in an outbreak this year in Minnesota,(www.statnews.com) where anti-vaccine activists had told Somali immigrants that vaccination is linked to autism, surpassed the total number of measles cases in the entire United States during 2016.
"Young parents are susceptible to misinformation," Pisani said.
These parents should be hearing accurate information, she said. For example, vaccination of children born between 1994 and 2016 has prevented 381 million illnesses and avoided 855,000 early deaths, and every dollar spent on childhood vaccines saves $10, according to the CDC. Containing just one case of measles costs about $140,000.
"Vaccines are the most economic drug on the market," Pisani said. "Many of them last a lifetime."
Falls, the leading cause of injuries among the elderly, is another growing public health problem that can be addressed by well-funded prevention programs. Thirty percent of adults older than 65 fall every year, contributing to about 27,000 deaths. The annual cost of fall injuries to Medicare is $31 billion and is projected to reach $52 billion in 2020.
Several community-based fall prevention programs that receive public funding have helped reduce the rate of falls among elderly participants between 30 percent and 55 percent.
"We shouldn't be penny-wise and pound-foolish," said Howard Bedlin, vice president for public policy and advocacy for the National Council on Aging. "These programs help people across the entire lifespan."
Diabetes is another costly illness that could be prevented with effective public health and wellness programs. Individuals who are at highest risk for developing type 2 diabetes could lower their risk by 58 percent with lifestyle intervention, according to a 2002 study.(www.ncbi.nlm.nih.gov) Payers could help by covering such intervention.
One obstacle to affirming the value of prevention programs is the mobility of insurance during a patient's lifetime. As people grow older, they are covered by many different insurers, which makes it difficult to track how investment in early prevention contributes to healthy outcomes, noted John Rother, president and CEO of the National Coalition on Health Care. Further, nonmedical services may not be reimbursed or appear in medical claims.
What is required, the panelists agreed, is a change in philosophy. When a new drug offers the potential to treat a disease or illness, expenses are not spared in bringing the drug to market, and the same urgency should apply to prevention programs.
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