Finkelstein, Jonathan, Newsweek
Byline: Jonathan Finkelstein
Health-care reform is only half the battle.
We've recently heard a lot about improving our health-care system, but less about improving our health--as individuals and as a nation. Although we pay the most for our health care, the U.S. has higher rates of preventable deaths from heart disease, diabetes, and stroke than almost all other industrialized nations. We have a medical-care payment system that rewards disease treatment much more than prevention.
How could doctors do better? In spite of controversy over some preventive screening (like mammograms in some age groups), we need to be clear about the proven health benefits of others. We must also better use computerized medical-record systems to remind doctors and patients to do the right things. And we need to work as a true team with nurses and other professionals to reach prevention goals.
And when we do steer patients toward proven preventive strategies, they don't always do as we suggest. The illnesses and injuries we protect against are often uncommon. Before laws discouraged it, many people never wore seat belts--and also never died in an automobile accident. Yet there is no doubt a person is at a greatly increased risk without a seat beat. Likewise, many parents recall measles as a mild illness because they've had no personal experience with the severe or fatal cases. Balancing this against often exaggerated vaccine-safety risks, they may decide not to immunize their kids. People respond to personal experience (and stories) more than statistics--we need to use both to promote prevention.
But it is lifestyle change that is of most value in disease prevention--and hardest to achieve. Occasionally, the healthy lifestyle message is easy for the doctor to explain, and for the patient to put into practice. "Wear a seat belt every time" is a clear edict that is reinforced by school teachers, public-health officials, and laws in almost all states ("click it or ticket"). It's obviously a lot harder to change more complex behaviors, like smoking. The percentage of smokers in the population has been cut in half due to the combination of public-health approaches (like warning labels on cigarettes) and new pharmacological approaches like nicotine replacement and other medicines. …