Prevention Matters

"Impending health care reform could take advantage of the extensive medical services system, at little additional cost, to accomplish many previously unattainable health goals for the nation. We could eliminate causes of disease and offer protection to all citizens," Anthony Robbins and Phyllis Freeman, co-editors of the Journal of Public Health Policy, noted recently in The Pump Handle. "Repeated references to “access to prevention services,” however, belie a failure to understand the difference between insuring personal health services and assuring public health gains. The distinction is a strategic one."

The pair resurrected a piece they authored for the Journal back in 1994 in the midst of Hillary Clinton's health care initiative. The piece spelled out specific steps for having the medical care system contribute to protecting the health of the population, more than just treating people seeking care. Those steps were 1) detecting problems in patients that may provide early warning of health threats to others in the community and reporting these to public health authorities for investigation; 2) acting on public health alerts–based on studies of harmful exposures in the environment– to target preventive, diagnostic, and therapeutic services to members of the population at risk; and 3) being part of systematic efforts to assure that every patient receives services of high public health value, such a vaccination, even if the patient is not sufficiently aware of the risks and benefits to seek these services.

"If our new President and the Congress accept the pervasive perception that universal access to medical services will address all important health needs, our nation will miss a magnificent opportunity to prevent disease and to hold off unnecessary medical care expenditures," they write in 2009. "Moreover, if Congress and the President do not get it right now, the door of political opportunity may not open for many years for a second chance."