Preventive healthcare | Wikipedia audio article

Preventive healthcare | Wikipedia audio article



preventive healthcare alternatively preventive medicine preventative healthcare medicine or prophylaxis consists of measures taken for disease prevention just as health comprises a variety of physical and mental states so do disease and disability which are affected by environmental factors genetic predisposition disease agents and lifestyle choices health disease and disability are dynamic processes which begin before individuals realize they are affected disease prevention relies on anticipate reactions that can be categorized as primal primary secondary and tertiary prevention each year millions of people die of preventable deaths a 2004 study showed that about half of all deaths in the United States in 2000 were due to preventable behaviors and exposures leading causes included cardiovascular disease chronic respiratory disease unintentional injuries diabetes and certain infectious diseases this same study estimates that 400,000 people die each year in the United States due to poor diet and a sedentary lifestyle according to estimates made by the World Health Organization who about 55 million people died worldwide in 2011 two-thirds of this group from non communicable diseases including cancer diabetes and chronic cardiovascular and lung diseases this is an increase from the year 2000 during which 60% of deaths were attributed to these diseases preventive health care is especially important given the worldwide rise in prevalence of chronic diseases and deaths from these diseases there are many methods for prevention of disease it is recommended that adults and children aim to visit their doctor for regular check-ups even if they feel healthy to perform disease screening identify risk factors for disease discussed hips for a healthy and balanced lifestyle stay up-to-date with immunizations and boosters and maintain a good relationship with a health care provider some common disease screenings include checking for hypertension high blood pressure hyperglycemia high blood sugar a risk factor for diabetes mellitus hypercholesterolemia high blood cholesterol screening for colon cancer depression HIV and other common types of surely transmitted disease such as chlamydia syphilis and gonorrhea mammography to screen for breast cancer colorectal cancer screening a Pap test to check for cervical cancer and screening for osteoporosis genetic testing can also be performed to screen for mutations that cause genetic disorders or predisposition to certain diseases such as breast or ovarian cancer however these measures are not affordable for every individual and the cost effectiveness of preventive health care is still a topic of debate topic levels of prevention preventive healthcare strategies are described as taking place at the primal primary secondary and tertiary prevention levels in the 1940s hue our level and eager knee clark coined the term primary prevention they worked at the harvard in columbia university schools of public health respectively and later expanded the levels to include secondary and tertiary prevention Goldston 1987 notes that these levels might be better described as prevention treatment and rehabilitation though the terms primary secondary and tertiary prevention are still in use today the concept of primal prevention has been created much more recently in relation to the new developments in molecular biology over the last 50 years more particularly in epigenetics which point to the paramount importance of environmental conditions both physical and affective on the organism during its fatal and newborn life or so called primal period of life topic primal and primordial prevention prevention has recently been propounded as a separate category of health promotion this health promotion par excellence is based on the new knowledge in molecular biology in particular on epigenetic knowledge which points to how much effective as well as physical environment during fetal and newborn life may determine each and every aspect of adult health this new way of promoting health consists mainly in providing future parents with pertinent unbiased information on primal health and supporting them during their child's primal period of life ie from conception to first anniversary according to definition by the primal Health Research Centre London this includes adequate parental leave ideally for both parents with kin caregiving and financial help where needed another related concept is primordial prevention which refers to all measures designed to prevent the development of risk factors in the first place early in life topic primary prevention primary prevention consists of traditional health promotion and specific protection health promotion activities are current non clinical life choices for example eating nutritious meals and exercising daily that both prevent disease and create a sense of overall well-being preventing disease and creating overall well-being prolongs our life expectancy health promotional activities do not target a specific disease or condition but rather promote health and well-being on a very general level on the other hand specific protection targets a type or group of diseases and complements the goals of health promotion food is very much the most basic tool in preventive health care the 2011 National Health Interview Survey performed by the Centers for Disease Control was the first national survey to include questions about ability to pay for food difficulty with paying for food medicine or both is a problem facing one out of three Americans if better food options were available through food banks soup kitchens and other resources for low-income people obesity and the chronic conditions that come along with it would be better controlled ER desert is an area with restricted access to healthy foods due to a lack of supermarkets within a reasonable distance these are often low-income neighborhoods with the majority of residents lacking transportation there have been several grassroots movements in the past 20 years to encourage urban gardening such as the green thumb organization in New York City urban gardening uses vacant lots to grow food for a neighborhood and is cultivated by the local residents mobile fresh markets are another resource for residents in a food desert which especially outfitted buses bringing affordable fresh fruits and vegetables to low-income neighborhoods these programs often hold educational events as well such as cooking and nutrition guidance programs such as these are helping to provide healthy affordable foods to people who need them scientific advancements in genetics have significantly contributed to the knowledge of hereditary diseases and have facilitated great progress in specific protective measures in individuals who are carriers of a disease gene or have an increased predisposition to a specific disease genetic testing has allowed physicians to make quicker and more accurate diagnoses and has allowed for tailored treatments or personalized medicine similarly specific protective measures such as water purification sewage treatment and the development of personal hygienic routines such as regular hand-washing became mainstream upon the discovery of infectious disease agents such as bacteria these discoveries have been instrumental in decreasing the rates of communicable diseases that are often spread in unsanitary conditions preventing sexually transmitted infections is another form of primary prevention topic secondary probe mention secondary prevention deals with latent diseases and attempts to prevent an asymptomatic disease from progressing to symptomatic disease certain diseases can be classified as primary or secondary this depends on definitions of what constitutes a disease though in general primary prevention addresses the root cause of a disease or injury whereas secondary prevention aims to detect and treat a disease early on secondary prevention consists of early diagnosis and prompt treatment to contain the disease and prevent it spread to other individuals and disability limitation to prevent potential future complications and disabilities from the disease for example early diagnosis and prompt treatment for a syphilis patient would include a course of antibiotics to destroy the pathogen and screening and treatment of any infants born to syphilitic mother's disability limitation for syphilitic patients includes continued checkups on the heart cerebrospinal fluid and central nervous system of patients to curb any damaging effects such as blindness or paralysis topic tertiary prevention finally tertiary prevention attempts to reduce the damage caused by symptomatic disease by focusing on mental physical and social rehabilitation unlike secondary prevention which aims to prevent disability the objective of tertiary prevention is to maximize the remaining capabilities and functions of an already disabled patient goals of tertiary prevention include preventing pain and damage halting progression and complications from disease and restoring the health and functions of the individuals affected by disease for syphilitic patients rehabilitation includes measures to prevent complete disability from the disease such as implementing workplace adjustments for the blind and paralyzed or providing counseling to restore normal daily functions to the greatest extent possible topic leading causes of preventable death topic United States the leading cause of death in the United States was tobacco however poor diet and lack of exercise may soon surpass tobacco as a leading cause of death these behaviors are modifiable and public health and prevention efforts could make a difference to reduce these deaths topic worldwide the leading causes of preventable death worldwide share similar trends to the United States there are a few differences between the two such as malnutrition pollution and unsafe sanitation that reflect health disparities between the developing and developed world topic child mortality in 2010 seven point six million children died before reaching the age of five while this is a decrease from nine point six million in the year 2000 it is still far from the fourth millennium development goal to decrease child mortality by two-thirds by the Year 2015 of these deaths about 64% were due to infection including diarrhea pneumonia and malaria about 40% of these deaths occurred in neonates children ages 1 to 28 days due to preterm birth complications the highest number of child deaths occurred in Africa and Southeast Asia in Africa almost no progress has been made in reducing neonatal deaths since 1990 India Nigeria Democratic Republic of the Congo Pakistan and China contributed to almost 50% of global child deaths in 2010 targeting efforts in these countries is essential to reducing the global child death rate child mortality is caused by a variety of factors including poverty environmental hazards and lack of maternal education the World Health Organization created a list of interventions in the following table that were judged economically and operationally feasible based on the healthcare resources and in restructure in 42 nations that contribute to 90% of all infant and child deaths the table indicates how many infant and child deaths could have been prevented in the year 2000 assuming universal health care coverage topic preventive methods topic obesity obesity is a major risk factor for a wide variety of conditions including cardiovascular diseases hypertension certain cancers and type 2 diabetes in order to prevent obesity it is recommended that individuals adhere to a consistent exercise regimen as well as a nutritious and balanced diet a healthy individual should aim for acquiring 10% of their energy from proteins 15 to 20 percent from fat and over 50% from complex carbohydrates while avoiding alcohol as well as foods high in fat salt and sugar sedentary adults should aim for at least half an hour of moderate level daily physical activity and eventually increased to include at least 20 minutes of intense exercise three times a week preventive health care offers many benefits to those that chose to participate in taking an active role in the culture the medical system in our society is geared toward curing acute symptoms of disease after the fact that they have brought us into the emergency room an ongoing epidemic within American culture is the prevalence of obesity eating healthier and routinely exercising plays a huge role in reducing an individual's risk for type 2 diabetes about twenty three point six million people in the United States have diabetes of those 17 point nine million are diagnosed and 5.7 million are undiagnosed 90 to 95 percent of people with diabetes have type 2 diabetes diabetes is the main cause of kidney failure limb amputation and new onset blindness in American adults topic sexually transmitted infections sexually transmitted infections st is such as syphilis and HIV are common but preventable with safe sex practices sti's can be asymptomatic or cause a range of symptoms preventive measures for sti's are called prophylactics the term especially applies to use the of condoms which are highly effective at preventing disease but also to other devices meant to prevent sti's such as dental dams and latex gloves other means for preventing STI is include education on how to use condoms or other such barrier devices testing partners before having unprotected sex receiving regular STI screenings to both receive treatment and prevent spreading sti's to partners and specifically for HIV regularly taking prophylactic antiretroviral drugs such as Truvada post exposure prophylaxis started within 72 hours optimally less than one hour after exposure to high-risk fluids can also protect against HIV transmission topic malaria prevention using genetic modification genetically modified mosquitoes are being used in developing countries to control malaria this approach has been subject to objections and controversy topic thrombosis thrombosis is a serious circulatory disease affecting thousands usually older persons undergoing surgical procedures women taking oral contraceptives and travelers consequences of thrombosis can be heart attacks and strokes prevention can include exercise anti embolism stockings pneumatic devices and pharmacological treatments topic cancer in recent years cancer has become a global problem low and middle-income countries share a majority of the cancer burden largely due to exposure to carcinogens resulting from industrialization and globalization however primary prevention of cancer and knowledge of cancer risk factors can reduce over one-third of all cancer cases primary prevention of cancer can also prevent other diseases both communicable and non-communicable that share common risk factors with cancer topic lung cancer lung cancer is the leading cause of cancer-related deaths in the United States and Europe and is a major cause of death in other countries tobacco is an environmental carcinogen and the major underlying cause of lung cancer between 25% and 40% of all cancer deaths and about 90% of lung cancer cases are associated with tobacco use other carcinogens include a space tiss and radioactive materials both smoking and secondhand exposure from other smokers can lead to lung cancer and eventually death therefore prevention of tobacco use is paramount to prevention of lung cancer individual community and statewide interventions can prevent or cease tobacco use 90% of adults in the u.s. who have ever smoked did so prior to the age of 20 in school prevention educational programs as well as counseling resources can help prevent and cease adolescent smoking other cessation techniques include group support programs nicotine replacement therapy NRT hypnosis and self motivated behavioral change studies have shown long-term success rates greater than 1 year of 20% for hypnosis and 10% to 20% for group therapy cancer screening programs serve as effective sources of secondary prevention the Mayo Clinic Johns Hopkins and Memorial sloan-kettering hospitals conducted annual x-ray screenings and sputum cytology tests and found that lung cancer was detected at higher rates earlier stages and had more favorable treatment outcomes which supports widespread investment in such programs legislation can also affect smoking prevention and cessation in 1992 Massachusetts United States voters passed a bill adding an extra 25 cent tax to each pack of cigarettes despite intense lobbying and a 7.3 million dollars spent by the tobacco industry to oppose this bill tax revenue goes toward tobacco education and control programs and has led to a decline of tobacco use in the state lung cancer and tobacco smoking are increasing worldwide especially in China China is responsible for about one third of the global consumption and production of tobacco products to Sacco control policies have been ineffective as China is home to three hundred and fifty million regular smokers and 750 million passive smokers and the annual death toll is over 1 million recommended actions to reduce tobacco use include decreasing tobacco supply increasing tobacco taxes widespread educational campaigns decreasing advertising from the tobacco industry and increasing tobacco cessation support resources in Wuhan China a 1998 school-based program implemented an anti tobacco curriculum for adolescents and reduced the number of regular smokers though it did not significantly decrease the number of adolescents who initiated smoking this program was therefore effective in secondary but not primary prevention and shows that school-based programs have the potential to reduce tobacco use topic skin cancer skin cancer is the most common cancer in the United States the most lethal form of skin cancer melanoma leads to over 50,000 annual deaths in the United States childhood prevention is particularly important because a significant portion of ultraviolet radiation exposure from the Sun occurs during childhood and adolescence and can subsequently lead to skin cancer in adulthood furthermore childhood prevention can lead to the development of healthy habits that continue to prevent cancer for a lifetime the Centers for Disease Control and Prevention CDC recommends several primary prevention methods including limiting sun exposure between 10 a.m. and 4 p.m. when the Sun is strongest wearing tighter weave natural cotton clothing wide brim hats and sunglasses as protective covers using sunscreens that protect against both UVA and UVB rays and avoiding tanning salons sunscreen should be reapplied after sweating exposure to water through swimming for example or after several hours of sun exposure since skin cancer is very preventable the CDC recommends school-level prevention programs including preventive curricula family involvement participation and support from the school's health services and partnership with community state and national agencies and organize a to keep children away from excessive UV radiation exposure most skin cancer and sun protection data comes from Australia and the United States an international study reported that Australians tended to demonstrate higher knowledge of sun protection and skin cancer knowledge compared to other countries of children adolescents and adults sunscreen was the most commonly used skin protection however many adolescents purposely used sunscreen with a low sun protection factor SPF in order to get a tan various Australian studies have shown that many adults fail to use sunscreen correctly many applied sunscreen well after their initial sun exposure and/or failed to reapply when necessary a 2002 case-control study in Brazil showed that only 3% of case participants and 11% of control participants used sunscreen with SPF greater than 15 topic cervical cancer cervical cancer ranks among the top three most common cancers among women in Latin America sub-saharan Africa and parts of Asia cervical cytology screening aims to detect abnormal lesions in the cervix so that women can undergo treatment prior to the development of cancer given that high-quality screening and follow-up care has been shown to reduce cervical cancer rates by up to 80% most developed countries now encourage sexually active women to undergo a Pap test every three to five years Finland and Iceland have developed effective organized programs with routine monitoring and have managed to significantly reduce cervical cancer mortality while using fewer resources than unorganized opportunistic programs such as those in the United States or Canada in developing nations in Latin America such as Chile Colombia Costa Rica and Cuba both public and privately organized programs have offered women routine cytological screenings since the 1970s however these efforts have not resulted in a significant change in cervical cancer incidence or mortality in these nations this is likely due to low quality in efficient testing however Porto Rico which has offered screening since the 1960's has witnessed an almost a 50 percent decline in cervical cancer incidents and almost a four-fold decrease in mortality between 1950 and 1990 Brazil Peru India and several high-risk nations in sub-saharan Africa which lack organized screening programs have a high incidence of cervical cancer topic colorectal cancer colorectal cancer is globally the second most common cancer in women and the third most common in men and the fourth most common cause of cancer death after lung stomach and liver cancer having caused 715 thousand deaths in 2010 it is also highly preventable about 80% of colorectal cancers Beginner's benign growths commonly called polyps which can be easily detected and removed during a colonoscopy other methods of screening for polyps and cancers include fecal occult blood testing lifestyle changes that may reduce the risk of colorectal cancer include increasing consumption of whole grains fruits and vegetables and reducing consumption of red meat see colorectal cancer topic health disparities and barriers to accessing care access to health care and preventive health services is unequal as is the quality of care received a study conducted by the agency for Healthcare Research and Quality AHRQ revealed health disparities in the United States in the United States elderly adults greater than 65 years old received worse care and had less access to care than their younger counterparts the same trends are seen when comparing all racial minorities black Hispanic Asian to white patients and low-income people to high income people common barriers to accessing and utilizing healthcare resources included lack of income and education language barriers and lack of health insurance minorities were less likely than whites to possess health insurance as were individuals who completed less education these disparities made it more difficult for the disadvantaged groups to have regular access to a primary care provider receive immunizations or receive other types of medical care additionally uninsured people tend to not seek care until their diseases progress to chronic and serious States and they are also more likely to forego necessary tests treatments and filling prescription medications these sorts of disparities and barriers exist worldwide as well often there are decades of gaps in life expectancy between developing and developed countries for example Japan has an average life expectancy that is 36 years greater than that in Malawi low-income countries also tend to have fewer physicians than high-income countries in Nigeria and Myanmar there are fewer than four physicians per 100,000 people while Norway and Switzerland have a ratio that is tenfold higher common barriers worldwide include lack of availability of health services and health care providers in the region great physical distance between the home and health service facilities high transportation costs high treatment costs and social norms and stigma toward accessing certain health services topic economics of lifestyle based prevention with lifestyle factors such as diet and exercise rising to the top of preventable deaths too mystics the economics of healthy lifestyle is a growing concern there is little question that positive lifestyle choices provide an investment in health throughout life to gauge success traditional measures such as the quality years of life method QALY show great value however that method does not account for the cost of chronic conditions or future lost earnings because of poor health developing future economic models that would guide both private and public investments as well as drive future policy to evaluate the efficacy of positive lifestyle choices on health is a major topic for economists globally Americans spend over 3 trillion a year on health care but have a higher rate of infant mortality shorter life expectancies and a higher rate of diabetes than other high-income nations because of negative lifestyle choices despite these large costs very little is spent on prevention for lifestyle caused conditions in comparison the Journal of American Medical Association estimates that 101 billion dollars was spent in 2013 on the preventable disease of diabetes and another 88 billion dollars was spent on heart disease in an effort to encourage healthy lifestyle choices workplace wellness programs are on the rise but the economics and effectiveness data are still continuing to evolve and develop health insurance coverage impacts lifestyle choices in a study by Sudan oh and Baker even intermittent loss of coverage has negative effects on healthy choices the potential repeal of the Affordable Care Act acha could significantly impact coverage for many Americans as well as the prevention and public health fund which is our nation's first and only mandatory funding stream dedicated to improving the public's health also covered in the Acker is counseling on lifestyle prevention issues such as weight management alcohol use and treatment for depression policymakers can have substantial effects on the lifestyle choices made by Americans because chronic illnesses predominate as a cause of death in the u.s. and pathways for treating chronic illnesses a complex and multifaceted prevention is a best practice approach to chronic disease when possible in many cases prevention requires mapping complex pathways to determine the ideal point for intervention cost effectiveness of prevention is achievable but impacted by the length of time it takes to see effects outcomes of intervention this makes prevention efforts difficult to fund particularly in strained financial contexts prevention potentially creates other costs as well due to extending the lifespan and thereby increasing opportunities for illness in order to assess the cost-effectiveness of prevention the cost of the preventive measure savings from avoiding morbidity and the cost from extending the lifespan need to be considered life extension costs become smaller when accounting for savings from postponing the last year of life which makes up a large fraction of lifetime medical expenditures and becomes cheaper with age prevention leads to savings only if the cost of the preventive measure is less than the savings from avoiding morbidity net of the cost of extending the life span in order to establish reliable economics of prevention for illnesses that are complicated in origin knowing how best to assess prevention efforts ie developing useful measures and appropriate scope is required topic effectiveness overview there is no general consensus as to whether or not preventive health care measures are cost effective but they increase the quality of life dramatically there are varying views on what constitutes a good investment some argue that preventive health measures should save more money than they cost when factoring in treatment costs in the absence of such measures others argue in favor of good value or conferring significant health benefits even if the measures do not save money furthermore preventive health services are often described as one entity though they comprise a myriad of different services each of which can individually lead to net costs savings or neither greater differentiation of these services is necessary to fully understand both the financial and health effects a 2010 study reported that in the United States vaccinating children cessation of smoking daily prophylactic use of aspirin and screening of breast and colorectal cancers had the most potential to prevent premature death preventive health measures that resulted in savings included vaccinating children and adults smoking cessation daily use of aspirin and screening for issues with alcoholism obesity and vision failure these authors estimated that if usage of these services in the United States increased to 90% of the population there would be net savings of 3.7 billion dollars which comprised only about minus 0.2 percent of the total 2006 United States healthcare expenditure despite the potential for decreasing health care spending utilization of healthcare resources in the United States still remains low especially among Latinos and African Americans overall preventive services are difficult to implement because healthcare providers have limited time with patients and must integrate a variety of preventive health measures from different sources while these specific services bring about small net savings not every preventive health measure saves more than it costs a 1970s study showed that preventing heart attacks by treating hypertension early on with drugs actually did not save money in the long run the money saved by evading treatment from heart attack and stroke only amounted to about a quarter of the cost of the drugs similarly it was found that the cost of drugs or dietary changes to decrease high blood cholesterol exceeded the cost of subsequent heart disease treatment due to these findings some argue that rather than focusing healthcare reform efforts exclusively on preventive care the interventions that bring about the highest level of health should be prioritized Co Annette al 2008 outline a few arguments made by skeptics of preventive health care many argue that preventive measures only cost less than future treatment when the proportion of the population that would become ill in the absence of prevention is fairly large the diabetes prevention program research group conducted a 2012 study evaluating the costs and benefits in quality adjusted life years or QALY zuv lifestyle changes versus taking the drug metformin they found that neither method brought about financial savings but were cost effective nonetheless because they brought about an increase in q al wise in addition to scrutinizing costs preventive health care skeptics also examine efficiency of interventions they argue that while many treatments of existing diseases involve use of advanced equipment and technology in some cases this is a more efficient use of resources than attempts to prevent the disease Co Annette al 2008 suggests that the preventive measures most worth exploring and investing in are those that could benefit a large portion of the population to bring about cumulative and widespread health benefits at a reasonable cost cost-effectiveness of childhood obesity interventions there are at least four nationally implemented childhood obesity interventions in the United States the sugar sweetened beverage excise tax SSB the TV ad program active physical education active PE policies and early care and education ECE policies they each have similar goals of reducing childhood obesity the effects of these interventions on BMI have been studied and the cost-effectiveness analysis CEA has led to a better understanding of projected cost reductions and improved health outcomes the childhood obesity intervention cost-effectiveness study choices was conducted to evaluate and compare the CEA of these four interventions got maker SL at al 2015 states the four initial intervention were selected by the investigators to represent a broad range of nationally scalable strategies to reduce childhood obesity using a mix of both policy and programmatic strategies one an excise tax of one cent per ounce of sweetened beverages applied nationally and administered at the state level SSB to elimination of the tax deductibility of advertising costs of TV advertisements for nutritionally poor foods and beverages seen by children and adolescents TV ad three state policy requiring all public elementary schools in which physical education PE is currently provided to devote 50% of PE class time to moderate and vigorous physical activity active PE and for state policy to make early child educational settings healthier by increasing physical activity improving nutrition and reducing screen time ECE the choice has found that SSB TV ad and ECE led to net cost savings both SSB and TV ad increased quality adjusted life years and produced yearly tax revenue of 12.5 billion u.s. dollars and 80 million u.s. dollars respectively some challenges with evaluating the effectiveness of child obesity interventions include the economic consequences of childhood obesity are both short and long-term in the short term obesity impairs cognitive achievement and academic performance some believe this is secondary to negative effects on mood or energy but others suggest there may be physiological factors involved furthermore obese children have increased healthcare expenses eg medications acute care visits in the long term obese children tend to become obese adults with associated increased risk for a chronic condition such as diabetes or hypertension any effect on their cognitive development may also affect their contributions to society and socioeconomic status in the choices it was noted that translating the effects of these interventions may in fact differ among communities throughout the nation in addition it was suggested that limited comes a study than these interventions may have an additional effect that is not fully appreciated modeling outcomes in such interventions in children over the long term is challenging because advances in medicine and medical technology are unpredictable the projections from cost-effective analysis may need to be reassessed more frequently the economics of preventive care in the u.s. t-h-e cost-effectiveness of preventive care is a highly debated topic while some economists argue that preventive care is valuable and potentially cost saving others believe it is an inefficient waste of resources preventive care is composed of a variety of clinical services and programs including annual doctor's checkups annual immunizations and wellness programs recent models show that these simple interventions can have significant economic impacts clinical preventive services and programs research on preventive care addresses the question of whether it is cost saving or cost effective and whether there is an economics evidence base for Health Promotion and disease prevention the need for an interest in preventive care is driven by the imperative to reduce healthcare costs while improving quality of care and the patient experience preventive care can lead to improved health outcomes and cost savings potential services such as health assessments screenings prenatal care and telehealth and telemedicine can reduce morbidity or mortality with low cost or cost savings specifically health assessments screenings have cost savings potential with varied cost-effectiveness based on screening and assessment type inadequate prenatal care can lead to an increased risk of prematurity stillbirth and infant death time is the ultimate resource and preventive care can help mitigate the time costs telehealth and telemedicine is one option that has gained consumer interest acceptance and confidence and can improve quality of care and patient satisfaction understanding the economics for investment there are benefits and trade-offs when considering investment in preventive care versus other types of clinical services preventive care can be a good investment as supported by the evidence base and can drive population health management objectives the concepts of cost saving and cost-effectiveness are different and both are relevant to preventive care for example preventive care that may not save money may still provide health benefits thus there is a need to compare interventions relative to impact on health and cost preventive care transcends demographics and is applicable to people of every age the health capital Theory underpins the importance of preventive care across the lifecycle and provides a framework for understanding the variances in health and health care that are experienced it treats health as a stock that provides direct utility health depreciates with age and the aging process can be counted through health investments the theory further supports that individuals demand good health that the demand for health investment is a derived Amann ie investment is health is due to the underlying demand for good health and the efficiency of the health investment process increases with knowledge ie it is assumed that the more educated are more efficient consumers and producers of health the prevalence elasticity of demand for prevention can also provide insights into the economics demand for preventive care can alter the prevalence rate of a given disease and further reduce or even reverse any further growth of prevalence reduction in prevalence subsequently leads to reduction in costs economics for Policy action there are a number of organizations and policy actions that are relevant when discussing the economics of preventive care services the evidence-based viewpoints and policy briefs from the Robert Wood Johnson Foundation the Organization for Economic Cooperation and Development OECD and efforts by the US Preventive Services Task Force USPSTF all provide examples that improve the health and well-being of populations eg preventive health assessments screenings prenatal care and tele health telemedicine the Patient Protection and Affordable Care Act PPACA akka has major influence on the provision of preventive care services although it is currently under heavy scrutiny and review by the new administration according to the Centers for Disease Control and Prevention CDC the Acker makes preventive care affordable and accessible through mandatory coverage of preventive services without a deductible co-payment coinsurance or other cost-sharing the US Preventive Services Task Force USPSTF of national experts in prevention and evidence-based medicine works to improve health of Americans by making evidence-based recommendations about clinical preventive services they do not consider the cost of a preventive service when determining a recommendation each year the organization delivers a report to Congress that identifies critical evidence gaps in research and recommends priority areas for further review the national network of perinatal quality collaboratives in NP QC sponsored by the CDC supports state-based perinatal quality collaboratives pqcs in measuring and improving upon health care and health outcomes for mothers and babies these pqcs have contributed to improvements such as reduction in deliveries before 39 weeks reductions in health care associated bloodstream infections and improvements in the utilization of antenatal corticosteroids telehealth and telemedicine has realized significant growth and development recently the Center for connected health policy the National tele Health Policy Resource Center has produced multiple reports and policy briefs on the topic of telehealth and telemedicine and how they contribute to preventive services policy actions and provision of preventive services do not guarantee utilization reimbursement has remained a significant barrier to adoption due to variances in payor and state level reimbursement policies and guidelines through government and commercial payers Americans use preventive services at about half the recommended rate and cost-sharing such as deductibles coinsurance or co-payments also reduce the likelihood that preventive services will be used further despite the ACA enhancement of Medicare benefits and preventive services there were no effects on preventive service utilization calling out the fact that other fundamental barriers exist the Affordable Care Act and preventive health care Patient Protection and Affordable Care Act also known as just the Affordable Care Act or Obamacare was passed and became law in the United States on March 23rd 2010 the finalized and newly ratified law was to address many issues in the US healthcare system which included expansion of coverage insurance market reforms better quality and the forecast of efficiency and costs under the insurance market reforms the Act required that insurance companies no longer exclude people with pre-existing conditions allow for children to be covered on their parents plan until the age of 26 expand appeals that dealt with reimbursement denials the Affordable Care Act also banned the limited coverage imposed by health insurances and insurance companies were to include coverage for preventive health care services the US Preventive Services Task Force has categorized and rated preventive health services as either A or B as to which insurance companies must comply and present full coverage not only has the US Preventive Services Task Force provided graded preventive health services that are appropriate for coverage they have also provided many recommendations to clinicians and insurers to promote better preventive care to ultimately provide better quality of care and lower the burden of costs health insurance and preventive care health care insurance companies are willing to pay for preventive care despite the fact that patients are not acutely sick in hope that it will prevent them from developing a chronic disease later on in life today health insurance plans offered through the marketplace mandated by the Affordable Care Act are required to provide certain preventive care services free of charge to patients section 2713 of the Affordable Care Act specifies that all private marketplace and all employer sponsored private plans except those grandfathered in a required to cover preventive care services that are ranked her or B by the US Preventive Services Task Force free of charge to patients for example united healthcare insurance company has published patient guidelines at the beginning of the year explaining their preventive care coverage evaluating incremental benefits of preventive care evaluating the incremental benefits of preventive care requires longer period of time when compared to acute ill patients inputs into the models such as discounting rate and time horizon can have significant effects of the results one controversial subject is use of ten year time frame to assess cost-effectiveness of diabetes preventive services by the Congressional Budget Office the preventive care services mainly focuses on chronic disease the Congressional Budget Office has whydid guidance that further research in the area of the economic impacts of obesity in the u.s. before the CBO can estimate budgetary consequences a bipartisan report published in May 2015 recognizes that the potential of the preventive care to improve patient's health at individual and population levels while decreasing the healthcare expenditure an economic case for preventive health mortality from modifiable risk factors chronic diseases such as heart disease stroke diabetes obesity and cancer have become the most common and costly health problems in the United States in 2014 it was projected that by 2023 that the number of chronic disease cases would increase by 42 percent resulting in four point two trillion dollars in treatment and lost economic output they are also among the top 10 leading causes of mortality chronic diseases are driven by risk factors that are largely preventable sub analysis performed on all deaths in the United States in the year 2000 revealed that almost half were attributed to preventable behaviors including tobacco poor diet physical inactivity and alcohol consumption more recent analysis reveals that heart disease and cancer alone accounted for nearly 46 percent of all deaths modifiable risk factors are also responsible for a large morbidity burden resulting in poor quality of life in the present and loss of future life earning years too it is further estimated that by 2023 focused efforts on the prevention and treatment of chronic disease may result in 40 million fewer chronic disease cases potentially reducing treatment costs by 220 billion dollars childhood vaccinations reduce health care costs childhood immunizations are largely responsible for the increase in life expectancy in the 20th century from an economic standpoint childhood vaccines demonstrate a very high return on investment according to healthy people 2020 for every birth cohort that receives the routine childhood vaccination schedule direct health care costs are reduced by nine point nine billion dollars in society saves thirty three point four billion dollars in indirect costs the economic benefits of childhood vaccinations extend beyond end of patience two insurance plans and vaccine manufacturers all while improving the health of the population prevention and health capital Theory the burden of preventable illness extends beyond the health care sector incurring significant costs related to lost productivity among workers in the workforce indirect costs related to poor health behaviors and associated chronic disease costs US employers billions of dollars each year according to the American Diabetes Association ADA medical costs for employees with diabetes are twice as high as for workers without diabetes and are caused by work-related absenteeism five billion dollars reduced productivity at work twenty point eight billion dollars inability to work due to illness related disability 21 point six billion dollars and premature mortality eighteen point five billion dollars reported estimates of the cost burden due to increasingly high levels of overweight and obese members in the workforce vary with best estimates suggesting four hundred and fifty million more missed work days resulting in one hundred and fifty three billion dollars each year in lost productivity according to the CDC healthy workforce in the field of economics the health capital model explains how individual investments in health can increase earnings by increasing the number of healthy days available to work and to earn income in this context health can be treated both as a consumption good wherein individuals desire health because it improves quality of life in the present and as an investment good because of its potential to increase attendance and workplace productivity over time preventive health behaviors such as healthful diet regular exercise access to are in use of well care avoiding tobacco and limiting alcohol can be viewed as health inputs that result in both a healthier workforce and substantial cost savings preventive care and quality adjusted life years health benefits of preventive care measures can be described in terms of quality adjusted life years q al wise saved a QALY takes into account length and quality of life and is used to evaluate the cost-effectiveness of medical and preventive interventions classically one year of perfect health is defined as one QALY and a year with any degree of less than perfect health is assigned a value between zero and one QALY as an economic weighting system the QALY can be used to inform personal decisions to evaluate preventive interventions and to set priorities for future preventive efforts cost-saving and cost effective benefits of preventive care measures are well established the Robert Wood Johnson Foundation evaluated the prevention cost effectiveness literature and found that many preventive measures meet the benchmark of 60 in certain populations alcohol and tobacco screening were found to be cost-saving in some reviews and cost effective in others according to the our wjf analysis two preventive interventions were found to save costs in all reviews childhood immunizations and counseling adults on the use of aspirin prevention in minority populations health disparities are increasing in the United States for chronic diseases such as obesity diabetes cancer and cardiovascular disease populations at heightened risk for health inequities are the growing proportion of racial and ethnic minorities including African Americans American Indians Hispanics Latinos asian-americans Alaskan Natives and Pacific Islanders according to the racial and ethnic approaches to community health reach a national CDC program non-hispanic blacks currently have the highest rates of obesity 48% and risk of newly diagnosed diabetes is 77 percent higher among non-hispanic blacks 66% higher among Hispanics Latinos and 18 percent higher among Asian Americans compared to non-hispanic whites current u.s. population projections predict that more than half of americans will belong to a minority group by 2044 without targeted preventive interventions medical costs from chronic disease inequities will become unsustainable broadening health policies designed to improve delivery of preventive services for minority populations may help reduce substantial medical costs caused by inequities in health care resulting in a return on investment policies of prevention chronic disease is a population level issue that requires population health level efforts a national and state-level public policy to effectively prevent rather than individual level effort the United States currently employs many public health policy efforts aligned with the preventive health efforts discussed above for instance the Centers for Disease Control and Prevention support initiatives such as health in all policies and hi-five health impact in five years collaborative efforts that aim to consider prevention across sectors and address social determinants of health as a method of primary prevention for chronic disease specific examples of programs targeting vaccination and obesity prevention in childhood are discussed in the sections to follow policy prevention of obesity policies that address the obesity epidemic should be proactive and far-reaching including a variety of stakeholders both in healthcare and in other sectors recommendations from the Institute of Medicine in 2012 suggests that concerted action be taken across and within five environments physical activity PA food and beverage marketing and messaging healthcare and work sites and schools and all sectors of society including government business and industry schools childcare urban planning recreation transportation media public health agriculture communities and home in order for obesity prevention efforts to truly be successful there are dozens of current policies acting at either or all of the federal state local and school levels most states employ a physical education requirement of 150 minutes of physical education per week at school a policy of the National Association of sport and physical education in some cities including Philadelphia of sugary food tax is employed this is a part of an amendment to title 19 of the Philadelphia Code finance taxes and collections chapter 19 – 4100 sugar sweetened beverage tax that was approved 2016 which establishes an excise tax of 0.01 $5 per fluid ounce on distributors of beverages sweetened with both caloric and non-caloric sweeteners distributors are required to file a return with the department and the department can collect taxes among other responsibilities these policies can be a source of tax credits for example under the Philadelphia policy businesses can apply for tax credits with the Revenue Department on a first come first-served basis this applies until the total amount of credits for a particular year reaches one million dollars recently advertisements for food and beverages directed at children have received much attention the children's food and beverage advertising initiative CF Bai is a self-regulatory program of the food industry each participating company makes a public pledge that details its commitment to advertise only foods that meet certain nutritional criteria to children under 12 years old this is a self-regulated program with policies written by the Council of Better Business Bureaus the Robert Wood Johnson Foundation funded research to test the efficacy of the CF Bai the results showed progress in terms of decreased advertising of food products that target children and adolescents to explore other programs and initiatives related to policies of childhood obesity visit the following organizations and online databases US Department of Agriculture Robert Wood Johnson Foundation supported bridging the gap program national association of county and city health officials yael Rudd Center for Food Policy and obesity Centers for Disease Control and Prevention's chronic disease state policy tracking system National Conference of State Legislators prevention institutes enact local policy database Organization for Economic Cooperation and Development OECD and the US Preventive Services Task Force USPSTF childhood immunization policies despite nationwide controversies over childhood vaccination and immunization there are policies and programs at the federal state local and school levels outlining vaccination requirements all states require children to be vaccinated against certain communicable diseases as a condition for school attendance however currently 18 states allow exemptions for philosophical or moral reasons diseases for which vaccinations form part of the standard ACIP vaccination schedule a diphtheria tetanus pertussis whooping cough polio myelitis polio measles mumps rubella Haemophilus influenzae type B hepatitis B influenza and pneumococcal infections these schedules can be viewed on the CDC website the CDC website describes a federally fund program vaccines for children vfc which provides vaccines at no cost to children who might not otherwise be vaccinated because of inability to pay additionally the Advisory Committee on Immunization Practices ACIP is an expert vaccination advisory board that informs vaccination policy and guides ongoing recommendations to the CDC incorporating the most up-to-date cost-effectiveness and risk benefit evidence in its recommendations an economic case conclusion there are economic and health related arguments for preventive health care direct and indirect medical costs related to preventable chronic disease are high and will continue to rise with an aging and increasingly diverse US population the government at federal state local and school levels has acknowledged this and created programs and policies to support chronic disease prevention notably at the childhood age and focusing on obesity prevention and vaccination economically with an increase in QALY and a decrease in lost productivity over a lifetime existing and innovative prevention interventions demonstrate a high return on investment and are expected to result in substantial health care cost savings over time equals equals see also

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