HEALTH MATTERS: Your health questions answeredQ. It makes sense to encourage preventing, rather than treating diseases. But do prevention programs actually work?
By: Dr. Joshua Wynne, Grand Forks Herald
Q. It makes sense to encourage preventing, rather than treating diseases. But do prevention programs actually work?
A. Prevention programs work, but with some qualifications. First of all, we believe that the most effective way of preventing unnecessary disability and premature death is through straightforward behavioral and lifestyle modifications.
It turns out that somewhere between one-third and one-half of all deaths in North Dakota are thought to be preventable if people would just do five simple things: Don’t smoke, control high blood pressure (usually by properly taking medications), avoid excess weight, exercise regularly and avoid excessive alcohol intake.
Not smoking (or stopping if you are a smoker) is by far the most important, accounting for almost one in five preventable deaths. Next in importance is controlling high blood pressure or hypertension. This usually means the patient is asked to consume a low-salt diet and often take one or more medications to bring the blood pressure down to an acceptable range.
We have good evidence that doing these five things can have a very positive effect on health, not that some of them are easy to do. If they were easy, then most people would obviously do them. But we in the health professions can help patients deal with each of these behavioral problems.
Other preventive programs that involve screening for disease, such as colonoscopy, breast mammography for women and prostate screening for men, can also catch a cancer at an earlier stage and thus increase the chance of a cure. But it turns out that this type of prevention — screening for disease at an early stage — is less beneficial than many people think. Although screening for early disease is useful and should be encouraged, the benefits are more modest than the lifestyle and behavioral modifications discussed earlier.
Q. If we prevent disease, will this save money and reduce health care costs?
A. Unfortunately, the answer is “not much.” This may surprise you, but consider these two factors. First, prevention programs such as mammography, colonoscopy and prostate screening cost money. We need to screen many people to find one early cancer and the bill for all of those screening tests adds up.
But there is a second, almost contrary to what you would expect, factor — if screening really does work and “cures” a cancer in its early stage, the patient will live longer. When someone lives longer, they are more likely to get a chronic disease such as diabetes or chronic lung disease that is more common in the elderly. Caring for people with chronic diseases costs a lot of money, and as we live longer, we spend more money on health care.
In fact, a senior citizen spends about 10 times as much on health care as a young child does. While we should encourage the use of prevention services so that we all can lead better, healthier, fuller and longer lives, we shouldn’t expect a major reduction in health care costs as a consequence.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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