AARP's position is that health promotion and disease prevention can change America. Some segments of the health care industry (eg, the Centers for Disease Control and Prevention, the Partnership for Prevention, and the US Preventive Services Task Force). are doing great work to promote health and prevent disease. But many sectors of the health care industry have not made this approach a priority. Our health care system gives us simultaneously the world's preeminent medical research enterprise and more than 47 million people who have no health insurance coverage. This system produces much more voluminous information about specific diseases than it does about how to maintain good health. Our remarkable publicly funded medical research is focused on understanding disease rather than understanding health. Privately funded pharmaceutical research and development is based on creating profitable interventions for disease and disorders. In short, this nonsystem is often more willing to pay for intervention than prevention. A redirected focus in these areas can improve the quality of life for millions of people and make health care affordable for government, corporations, employees, and families as the population ages and becomes more diverse.
Prevention and wellness should be a top national priority. We need to work together to transform our "sick care" system to a "health care" system that values and invests in prevention and wellness. We must move from a system that focuses on treating illness to one that also prevents disease.
The National Business Group on Health found that almost 47% of deaths in the United States in 2000 were caused by modifiable health behaviors; tobacco use, poor diet, and physical inactivity were the largest culprits (3
). The Commonwealth Fund estimates that, with a modest investment, we could save the health care system $493 billion over 10 years by reducing the prevalence of tobacco use and obesity, creating incentives for participation in wellness programs and adoption of healthy behaviors, and covering preventive services (4
Attempts to move toward a health system model that focuses more on health promotion and disease prevention have been successful only to a limited degree. Coherence and synergy are needed to unify the efforts of state and local government agencies, whose programs depend on government funding and political will. Even some successful programs — such as the National High Blood Pressure Education Program at the National Heart, Lung, and Blood Institute or the youth tobacco control programs in Florida and Mississippi — have been severely cut back due to budget constraints or shifts in priorities (2
This is a complex problem that requires a multifaceted approach. To succeed at health promotion and disease prevention we need to 1) create environmental change, so that appropriate behavior is seen as normative behavior, which means changing the environment in which people actually live, work, and play, and 2) focus on behaviors by teaching people how to take the proper steps to good health or healthy living.
Clinical settings can contribute to both environmental change and individual behavior change. They are an important part of the solution, but people do not live in clinical settings. They live in supermarkets, convenience stores, schools, playgrounds, restaurants, offices and factories. They also live in a media society — in front of televisions, video games, movies, computer screens, and cell phones … and especially on couches.
A major public-private partnership that has broad representation from all stakeholders — including health care, insurance, the food industry, agriculture, educators, consumers, media, advertising, government, and research — is essential to draw attention to the importance of health promotion and disease prevention. Such a broad partnership would make prevention a national priority and provide a focal point for action. It would advance policies and practices to prevent disease and improve health and it would offer national, coordinated leadership for wellness and prevention activities.