Robert A. Aronowitz
Situating Health Risks
An Opportunity for Disease-Prevention Policy
The health care issues that capture significant public and professional attention are not necessarily the most important. As potential points of policy intervention, some intellectual assumptions, clinical practices, and structural relationships are so tightly woven into social, economic, and scientific life that they are in some sense invisible. Take, for example, one of the most contentious American health-policy controversies in recent years—Medicare coverage for prescription medications. Participants in this controversy have focused almost exclusively on financial and administrative issues such as cost, the scope of benefits, and the role of private insurers. Seemingly—and strangely— absent from political and policy debates is any mention of which drugs seniors take and why. But consider that twenty of the forty-six drugs most widely used by the elderly in 2000 were drugs prescribed to treat asymptomatic "risk factors" such as osteoporosis and hypertension.1
The definition, scope, and significance of many of these health risks, such as the treatment of high serum cholesterol levels in the elderly, have been widely contested (Alibhai and Rochon 1998; Aronow 2002; Eisenberg 1991; Froom 1991; LaRosa 2002; Oliver 1997; Wenger 2002). In addition, the demand for risk-reducing medications has been heavily influenced by direct marketing to consumers, the sometimes exaggerated claims of self-interested parties, and problematic assumptions used in the extrapolation of aggregate data to individual decisions. I want to argue here that developments leading to this state of affairs represent missed opportunities for policy analysis and intervention. Understanding them as policy issues has the potential to significantly impact both population health and our economic well-being.