Prevention Matters

Jacob Goldstein at the Health Blog came across a table in the Obama administration's budget outline that lays out pretty clearly what spending cuts are being proposed to help fund a $630 billion “reserve fund” to help pay for health reform. Take a look here.

The prospect of electronic cigarettes being allowed on airplanes was named Partnership for Prevention's Worst Idea of the Week, while the prospect of New Hampshire joining the other 49 states in adopting a mandatory seat belt law was named the Best Idea of the Week.

The Best/Worst honors are a regular feature of Prevention Matters. Each week, Partnership for Prevention's staff will choose the designees based on nominations of items in the previous week’s news submitted by members, staff and the public at large. To submit a nomination or for more information, contact Damon Thompson at dthompson@prevent.org .


WORST IDEA:
E-Cigs to Restore Lighting Up on Airplanes?

A Belgian company hopes its "electronic cigarette" once again makes lighting up part of the in-flight experience. SuperSmoker says its electronic cigarette delivers nicotine through tobacco-flavored vapor without the annoying smoke of a true cigarette, which means "this device can't be placed under the smoking prohibition" that bars smoking on flights. The smokeless cigs were launched in Europe last spring, and now SuperSmoker says it is talking to at least one unnamed airline about allowing the battery-powered butts aboard long-haul flights. It also will be showing off the technology at the Aircraft Interiors Expo next month.

More details online at http://blog.wired.com/cars/2009/02/remember-the-da.html

BEST IDEA:
Despite “Live Free or Die” Motto, New Hampshire May Adopt Seat Belt Law

Legislators in the “Live Free or Die” state may soon trade a bit of their citizens’ independence for a pot of gold from Washington, D.C. The New Hampshire House of Representative recently voted 197 to 155 to adopt a mandatory seat belt law for all automobile drivers and passengers. New Hampshire is the only state not to have either a primary or secondary seat belt law for adults.

More details online at http://www.wptz.com/cnn-news/18753246/detail.html

Twenty-six of the nation's leading tobacco control researchers and policy experts - including Partnership for Prevention Interim President Corinne G. Husten - today called for regulatory control of all tobacco products. In a blueprint they drafted to apply harm reduction principles to addreess tobacco addication, they also called for policies that encourage current tobacco users to reduce their health risks by switching from the most to the least harmful nicotine-containing products.

Dorothy Hatsukami, who co-chaired the two-year effort, said the blueprint "lays out the key elements of a science-based regulatory program and policies to shift current tobacco users away from cigarettes. With these policies and programs, we believe that the death toll from cigarette smoking and other tobacco use can be reduced dramatically."

The director of the Congressional Budget Office today told the Senate Finance Committee it may be decades before costs savings are realized from any overhaul of the $2.3 trillion U.S. healthcare industry. Even so, CBO Director Douglas Elmendorf repeated CBO's recent assertions that prevention programs would not contribute to those savings. "They would definitely improve health, but it's not so certain that they would save money," Elmendorf said.

In anticipation of Elmendorf's testimony, Partnership for Prevention released a white paper prepared by leading public health and prevention authorities that said the CBO's take on prevention programs "misses the point" of health reform. They called recent CBO assessments of prevention programs “short-view, narrowly focused analyses” that “tabulate the often sizable upfront costs of covering preventive services but ignore their subsequent payback over time.”

The Centers for Medicare and Medicaid Services (CMS) has forecast that the share of the economy devoted to health spending will jump a full percentage point this year. The jump from 16.6% to 17.6% would mark the biggest one-year increase recorded since the government began tracking the data in 1960.

Hopefully, this will put to rest the notion that we can't afford to do health reform right away. There are signs that people are getting this message:

New York Times: "While some people have predicted that Mr. Obama would have to shelve his priorities given rising deficits, his determination to proceed, especially on health care, reflects his economic advisers' conviction that the government cannot control its finances without reforming health care."

Long Island Newsday: "Whenever this tsunami of acute economic problems finally ebbs, the chronic problem of out-of-control medical costs will take center stage as an impediment to a healthy future," and while "it may take broad reform to fashion an affordable, sustainable health care system ... the effort has to start now," a Newsday editorial states.

Joe Conason, Salon: Neither the fiscal responsibility summit "nor any other serious discussion of fiscal problems can be confined to entitlement programs -- because the underlying issue is health care costs."

R.J. Reynolds helped build the city of Winston-Salem, N.C. Just repeating the city's name invokes two of the world's most popular cigarette brands. You can't get any deeper into tobacco country. Knowing all that helps you appreciate the drama associated with a Feb. 15 editorial in the Winstom-Salem Journal backing legslation that would ban smoking in virtually all enclosed workplaces and buildings open to the public in North Carolina. In a piece signed by the Journal Editorial Staff, the paper declared:

"The tobacco industry has put food on our tables; it built our hospitals, colleges and churches and supported our charities. Tobacco has been a proud, hard-working way of life for everyone from farmers to factory workers, a way of life we have long supported on this page.

"But starting today, with the full gravity of overwhelming medical evidence against second-hand smoke weighing on our judgment, we must break with the past and support further restrictions against smokers, in the interest of public health."

Strong stuff.

When considering the opinions of economists who say prevention costs too much because it makes people live longer, it might be wise to keep in mind these words from from Nobel Prize winner Friedrich A. Hayek’s “Pretence of Knowledge” Speech:

“Unlike the position that exists in the physical sciences, in economics and other disciplines that deal with essentially complex phenomena, the aspects of the events to be accounted for about which we can get quantitative data are necessarily limited and may not include the important ones. While in the physical sciences it is generally assumed, probably with good reason, that any important factor which determines the observed events will itself be directly observable and measurable, in the study of such complex phenomena as the market, which depend on the actions of many individuals, all the circumstances which will determine the outcome of a process, for reasons which I shall explain later, will hardly ever be fully known or measurable. And while in the physical sciences the investigator will be able to measure what, on the basis of a prima facie theory, he thinks important, in the social sciences often that is treated as important which happens to be accessible to measurement.“

Prevention critics claim that preventing illness causes people to live longer, which results in costs to Social Security and other social programs that outweigh the savings accrued by preventing the initial illness. But when you suggest that helping people live healthier lives makes them more productive, they respond that they cannot measure that.

Thanks to Healthcare Economist for coming up with the Hayek quote.

The Wall Street Journal's Jacob Goldstein blogs a brief but interesting profile on Kathleen Sebelius, the Kansas governor who currently appears to top the list of candidates for Secretary of Health and Human Services.

"Sebelius spent eight years as her state’s insurance commissioner — key experience for a job that includes overseeing Medicare, the gargantuan federal insurance program for the elderly," Goldstein writes. "During that time, she blocked the sale of Blue Cross and Blue Shield to an out-of-state company because it would have raised premiums, the NYT says, and served as president of the National Association of Insurance Commissioners.

"During her two terms as governor, her administration has been notably bipartisan — she was elected to her first term with a former Republican businessman as her running mate, and ran a second time with the former state Republican party chairman on her ticket, the NYT reports. That’s important, given the polarizing nature of health-care questions, and the power Republicans still wield in the Senate.

"Still, she’d be unlikely to hold the dual role planned for Daschle, which included not only running HHS but also holding down an office in the White House to spearhead Obama’s health-reform plans."

A new report details the tobacco industry's latest attempts at “feminizing” cigarettes to attract a whole new generation of female smokers. Wrapping cigarettes in pretty colors and packaging them like cosmetics don’t change the facts. In the U.S., more than 20 million adult women and more than 1.5 million girls currently smoke cigarettes, putting them at risk for heart attacks, stroke, lung cancer, emphysema and other life-threatening illnesses. Each year more than 170,000 women die from smoking-caused diseases.

Deadly in Pink: Big Tobacco Steps Up Its Targeting of Women and Girls traces the history of tobacco company efforts to woo females that began in the 1920s, stepped up with the creation of Virginia Slims and continues today. The report, authored by the Campaign for Tobacco-Free Kids, American Cancer Society Action network, American Heart Association, American Lung Association and the Robert Wood Johnson Foundation, highlights the latest marketing assault on girls and women spearheaded by Philip Morris USA and R.J. Reynolds.

What can be done to prevent the devastating consequences for women’s heath? Passing federal legislation giving the U.S. Food and Drug Administration the authority to regulate the manufacturing, marketing and sale of tobacco products will crack down on marketing that makes tobacco products appealing to children; ban misleading health claims such as “light” and “low tar” that have often been targeted to women; stop tobacco companies from manipulating their products in ways that increase addiction and harm; and require larger health warnings that better inform consumers and reduce effectiveness of the cigarette pack as a marketing tool.

Research in developed countries has long shown that income disparities translate into significant gaps in health and longevity. But a new study shows that smoking obliterates any such advantage. According to its authors, the extra years of life that, on average, come with being in the highest social brackets are more than wiped out by smoking. The finding is based on tracking of mortality rates over a 28-year period among 15,000 men and women entering into old age.

Starting today, Partnership for Prevention begins a weekly feature on this blog in which we recognize the best and worst prevention ideas that made news within the past week. We solicit nominations from the Partnership staff, which then votes on the weekly winners. If you should come across anything that you feel is worthy of a nomination, please e-mail it to us at dthompson@prevent.org.

This week's winners:

BEST IDEA:

The Prevention and Wellness Fund - The economic stimulus package signed into law on Tuesday included included $1 billion for a Prevention and Wellness Fund, which will be used to fund key initiatives related to disease prevention and health promotion. While it was much less than the $5.8 billion sought in the Senate's original version of the bill, it still represents the single largest one-time infusion of resources into the U.S. public health system. Partnership for Prevention’s recommendations to Congress that were unveiled in December included the creation of a discrete, sustainable funding source to support state and local core public health activities and provide incentives for states to meet specified public health objectives.


WORST IDEA:

We actually had a tie between two alcohol-related stories:

Wasteful Whiskey Rebellion: Distillery executives in Kentucky recently poured bottles of bourbon on the steps of the state capitol to protest a proposed 6 percent sales tax increase on alcohol. Despite their objections, the legislature approved the tax hike and the governor signed it into law on Saturday. Studies show that taxing alcoholic beverages is an effective public health strategy for reducing the burden of alcohol-related disease. In the February 11th issue of Join Together, Cambridge Quarterly of Healthcare Ethics co-editor Steve Heilig noted that alcohol taxes have been largely ignored in recent years while the public has turned its attention to taxing tobacco to fund health initiatives. So the most recent "whiskey rebellion" not only ran counter to good science and good public health, but it was a waste of good bourbon.

Rise of the "Beer Pong Lobby:" An impassioned online campaign by leagues of beer-pong players led a veteran state senator in Maryland to abandon his effort to ban drinking games such as beer pong and flip cup in Baltimore bars. Sen. George W. Della Jr., a Baltimore Democrat, felt such games encourage excessive drinking and led to raucous behavior in city neighborhoods. "We had a campaign going to get everybody to contact the senator, and I was really happy to see all the people that came together," said Jim Reiter, co-founder of MD Beer Pong, which bills itself as the state's largest beer-pong league.

The Kennesaw, Ga., city council Monday night approved a plan that would impose a health insurance surcharge on high-risk employees who don't take part in city-sponsored wellness programs. Under the policy, high-risk employees can join stop-smoking and weight-loss programs or meet weekly with a coach to address other risk factors. Smokers who don't do so will pay a surcharge of $25 per pay period, while high-risk non-compliant employees will pay a surcharge of $50 per every two-week pay period.

Currently, 125 of Kennesaw’s 233 employees attend wellness programs, which began a year ago. Mandatory health screenings began in the fall. The state of Georgia's insurance charges are $40 a month more for employees who smoke and are not in a smoking cessation program.

While some people may argue about the health effects of second-hand smoke, a lot of them say they would be willing to stop smoking to preserve the health of the family pet.

An online survey conducted by the Henry Ford Health System in Detroit found that almost one in three smokers said the health of a pet would motivate them to try to kick the habit. Mewanwhile, 16 percent of non-smoking pet owners said their pet's health would motivate them to ask a smoking family member to quit, and 24 percent said they would at least ask the smoker to take smoke outside the building they are in.

Sounds like the makings of a new public health ad campaign.

In 1998, Altria's Philip Morris USA subsidiary voluntarily established a Youth Smoking Prevention department, and has long touted its efforts in that area. So how's it doing? According to a new survey by the Centers for Disease Control and Prevention, Altria's Marlboro brand is the most frequently smoked cigarette among middle school and high school students who smoke.

Could it have something to do with the fact that Marlboro is the most heavily advertised cigarette brand in the country? Or that data have shown that youth-oriented anti-smoking media campaigns funded by the tobacco industry tend to increase smoking?

In fact, the CDC study showed that the three most heavily advertised cigarette brands - Marlborough, Camel and Newport - are the brands of preference for nearly 80 percent of middle school smokers and for nearly 90 percent of high school smokers.

This is just one more reason that Partnership feels that Congress needs to introduce and pass legislation to allow the Food and Drug Administration to regulate the tobacco industry and its marketing practices. And it's why we need to fund more mass media campaigns that aren't dependent upon the tobacco industry for support.

Opponents might argue that it’s beckoning back to the days of prohibition, but increasing the alcohol excise tax is a valid strategy to improve the nation’s economy and health status. Tobacco taxes have been increased several times over the last few years for the very same reasons, yet it has been more than 18 years since the taxes on alcohol were raised. A commentary by Steve Heilig in the February 11th issue of Join Together provides a solid argument on the importance of increasing the alcohol tax—at both the state and federal levels.

UPDATE: Kentucky bourbon industry officials emptied bottles of bourbon on the state Capitol's front steps Tuesday to protest a proposed 6-percent sales tax on all distilled spirits. Despite this attempt at a new "whiskey rebellion," the state House Appropriations and Revenue Committee approved the proposal in an effort to offset a projected $456 million revenue shortfall in the fiscal year that ends June 30.

Initial reports indicate that prevention and wellness funding squeezed out a win in the economic stimulus package hammered out by House-Senate conferees today on Capitol Hill.

More details to come, but so far we're told the $789 billion package includes $1 billion under the category of Prevention -Wellness Trust (including 317 Immunizations), and 500 million for the health workforce.

The House had sought $3 billion for those provisions in its version of the bill, while the Senate originally sought $5.8 billion but zeroed out that funding to accommodate moderate Republicans who provided the votes needed to get the bill through the Senate.

While the final $1.5 billion figure falls short of original hopes, it still represents the single biggest infusion of support ever given to the nation's public health system.

As Congress deliberated on an economic stimulus plan, an AIDS worker on the other side of the country eloquently voiced the questions that are on the minds of public health officials everywhere.

"Are positions building highways of more importance than positions promoting good health?" Michael Kaplan, executive director at Cascade AIDS Project in Oregon, asked in a guest column that appeared in today's edition of "The Stump," a blog produced by The (Portland) Oregonian's Editorial Board. "Does a salaried construction worker spend less in our communities than a salaried public health specialist? Are positions focused on green energy -- efforts that save on fuel costs in the long run -- of more value than positions focused on health promotion that save on health care costs in the long run?

"The reality is that some members of Congress have decided which sectors of society they care for more, and it seems those who serve private interests over the public good are winning," Kaplan said. "At a time when the economy will only further decimate the public health system -- a system already ailing -- how is it we can say there is no need to support the return of jobs to help with this important work for our community?"

The Senate's 61-37 vote today to pass its version of an economic stimulus package sends the legislation to a House-Senate conference committee to sort out differences between their respective versions. One of those differences has to do with funding for prevention and wellness agencies and programs. The House version would appropriate $3 billion; the Senate originally sought $5.8 billion, but dropped funding for it entirely to reach a compromise that delivered the three moderate Republican votes needed to secure a filibuster-proof majority vote.

The action over the last 24 hours has been fast and furious, and the final version of the bill could be delivered very quickly. The big question now is: is there any room for compromise, or do the moderate Republicans constitute a "gang of three" that essentially controls the future of the bill?

Partnership for Prevention is urging House conferees to hold firm for the prevention and wellness funding. "At $3 billion, this fund represents less than one-half of a percent of the total funding package," said Partnership Interim President Corinne G. Husten. "However, it will create an estimated 17,000 jobs while providing immediate assistance to State and local public health agencies and programs that are critical components of the nation’s safety net."

House Democratic conferees are expected to be Speaker Pelosi and Representatives Obey, Hoyer, Clyburn, Frank, Gordon, Miller, Oberstar, Rangel, Spratt, Towns, Velasquez and Waxman.

The New Republic's health care blog quotes a senior administration official as saying that health care will be a “central focus” of Obama’s first budget proposal.

“I’ve been in meetings with him and it’s clear this guy is committed to getting health care and getting coverage to everybody,” one high-ranking member of the administration told TNR’s Jonathan Cohn. “There’s no question in my mind.”

The statement is meant to reassure reform advocates who had feared that the recent Daschle debacle and subsequent elimination of public health funding in the economic stimulus plan had taken some of the wind out of their sails.

Disease prevention and health promotion has taken some hits recently on the grounds that it doesn't save money. Health Affairs, the Congressional Budget Office and The Washington Post have all published studies or commentary contending that any savings realized through prevention is offset by the additional expenses incurred when people live longer.

Concerned that prevention could be dismissed as a important part of health reform efforts in Congress, members of the prevention community began pushing back recently. Partnership for Prevention commissioned a white paper from some of the nation's leading authorities on prevention and public health who made the economic case for prevention. One of the authors of that paper, Steven H. Woolf, MD, MPH, of Virginia Commonwealth University, then summarized that paper in a commentary that appeared in the Feb. 4 issue of JAMA. Partnership and the WellPoint Foundation then held congressional briefings on Capitol Hill on Feb. 4 in which Woolf was joined by Partnership Interim President Corinne G. Husten and Marc Manley, MD, Medical Director and Vice President at Blue Cross/Blue Shield of Minnesota.

Their conclusions: some preventive measures save money and some don't, but many provide enormous value in terms of health benefits per dollar spent. It is this value - translated into the ability to stem the increase in chronic diseases that are driving health costs upward - that need to be more closely considered as we seek to reform the health care system. And that should apply to medical treatments as well.

The briefing was recorded and can be watched online by clicking the TV set pictured on the right.