Prevention Matters

A Mississippi school’s establishment of a fitness room for teachers was named Partnership for Prevention's "Best Prevention Idea of the Week," while an animal rights group’s billboard that mocked fat people in an attempt to turn them against eating meat was named the “Worst Prevention Idea of the Week.”

The Best/Worst Idea awards are a regular feature of Prevention Matters, the blog of Partnership for Prevention. 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.



BEST

Middle School Teachers Working Up A Sweat
http://www.wapt.com/news/20603446/detail.html

Byram Middle School in Mississippi recently created its own fitness room for teachers to use while they're at school. The school now has two treadmills that allow teachers the opportunity to work out between classes. Teacher Lisa White said if the students see her putting in the time to work out, it will have a positive effect. “They mirror what they see and I can't sit there in the classroom and talk about health and not do anything about my own,” White said.


WORST

PETA Anti-Meat Billboards Derides Fat People
http://www.firstcoastnews.com/news/local/news-article.aspx?storyid=143891&catid=3

People for the Ethical Treatment of Animals (PETA) erected a billboard in town earlier this month that was designed to get people to stop eating meat. It depicted an overweight woman in a swimsuit, and had the words "Save the Whales." The organization replaced the billboards, after hearing objections from people who were offended by an approach they said made fun of the overweight.

Teens who have seen their parents drunk are more than twice as likely to get drunk in a typical month, and three times more likely to use marijuana and smoke cigarettes, when compared to teens who have not seen their parents drunk. Those are among the results of the 2009 Teen Survey from the National Center on Addiction and Substance Abuse (CASA) at Columbia University.

"Some Moms' and Dads' behavior and attitudes make them parent enablers—parents who send their 12- to 17-year olds a message that it's okay to smoke, drink, get drunk and use illegal drugs like marijuana," said Joseph A. Califano, Jr., CASA's chairman and founder and former U.S. Secretary of Health, Education, and Welfare. "...Teens' behavior is strongly associated with their parents' behavior and expectations, so parents who expect their children to drink and use drugs will have children who drink and use drugs."

Two of Partnership for Prevention's policy team will take part in a free Aug. 28 Wellsteps webinar entitled "How Will Health Care Reform Change Worksite Wellness?"

Garry Lindsay, Managing Senior Fellow and Senior Program Officer, and Ripley Forbes, Director, Legislative and Policy Advocacy, will take part in a panel discussion, which will take place from 11:00 a.m.-12:00 Noon EDT. Joining them will be Michael P. O'Donnell, MBA, MPH, PhD, the Editor in Chief of the American Journal of Health Promotion and Chairman of Health Promotion Advocates. Steven G. Aldana, Ph.D., a former professor of lifestyle medicine at Brigham Young University, who is currently the CEO and founder of WellSteps, will moderate the panel discussion.

Wellsteps is a turnkey wellness program designed to help employees adopt and maintain healthy behaviors for life. WellSteps webinars feature “the nation's leading worksite wellness experts” who share best practices, programming ideas, and evidence based solutions to common worksite wellness challenges.

Vaccinations will be the main defense against the swine flu epidemic in the US, says HHS Secretary Kathleen Sebelius.

"I think it's important that people begin to anticipate that we will have a vaccine," Sebeilus said in a "TODAY Show" interview. "We think it's likely that we're going to need two shots for the vaccine."

She said people should plan ahead for this, particularly those with pre-existing medical conditions, pregnant women and health care industry workers. Sebelius said federal health authorities also are recommending that people should immediately get their regular "seasonal" flu vaccine to bolster their health for the scenario yet to play out later this year regarding the swine flu virus.

"What we learned last spring is that shutting a school down sort of pre-emptively doesn't stop the virus from spreading," Sebelius added.

People who are 80 or more pounds over a normal weight live three to 12 fewer years than their normal-weight peers, a new study shows. Just being overweight or moderately obese, however, has little or no effect on life span, the research found.

An op-ed in The New York Times claims that, over the last three decades, the Congressional Budget Office (CBO) has underestimated the amount of savings and overestimated the costs that major changes in the health care system would bring.

"As Congress now works on its greatest push for health care reform in generations, the budget office needs to revise the methods it uses to make predictions about costs," writes John Gabel, senior fellow at the National Opinion Research Center of the University of Chicago.

Drawing on Commonwealth Fund-supported research, Gabel analyzed CBO's forecasts of three major changes in the Medicare program relative to their ultimate outcomes. He found that:

• in the early 1980s, CBO underestimated savings from reforms Congress made in the way Medicare paid hospitals by $11 billion.
• savings from the Balanced Budget Act of 1997, which changed the way skilled nursing facilities and home health services were reimbursed under Medicare, turned out to be 50 percent greater in 1998 and 113 percent greater in 1999 than the budget office forecast.
• the Medicare Modernization Act of 2003, which added prescription drug benefits to Medicare, cost nearly 40 percent less than the $206 billion predicted by CBO.

Gabel says CBO's current process to analyze initiatives aimed at reducing costs requires considerable evidence that similar previous policy changes have saved money. He says when there is a lack of historical examples, the "unknown" variable often becomes zero. The task for the budget office becomes even more challenging, he says, when it considers the impact of more than one change simultaneously—changes that might have synergies.

Statement from Robert J. Gould, President/CEO, Partnership for Prevention:

Senator Kennedy’s passing is an inestimable loss to government, to history and to the cause of health reform. A summary of his accomplishments shows that every piece of major health care legislation passed over the last four decades has borne his imprint. His lifelong devotion to the cause of making quality health care available to every American speaks volumes about his heart and his character.

Our thoughts today are with the senator’s family and friends. To those who share his dream of health reform, we would suggest that the greatest tribute would be to take to heart his own words:

“For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives, and the dream shall never die.”

The Food and Drug Administration will create a 12-person advisory panel to guide the agency as it gears up to regulate the tobacco industry. It will advise the FDA on sensitive issues including the impact of menthol in cigarettes, the use of descriptors such as "light" on tobacco packages, and the marketing of smokeless tobacco.

The agency is seeking nominations for the panel members. Eight of the members will be experts in medicine, medical ethics science and tobacco technology, according to a press release from the FDA. Three members from the industry, who won't have voting power, will be taken from small and large tobacco manufacturing companies and tobacco farmers. There will be one person from the general public on the panel.

Dr. Helene Gayle, an AIDS expert who serves as president and chief executive of the charity CARE USA, has been named to chair the Presidential Advisory Council on HIV/AIDS.Gayle is a former head of AIDS research at the U.S. Centers for Disease Control and Prevention who also headed AIDS efforts at the Bill & Melinda Gates Foundation before becoming the head of CARE USA. She will advise President Barack Obama on fighting the virus, which has infected an estimated 1 million Americans and 33 million people globally.

The New York Times reports that public health officials are considering the promotion of routine circumcision for all baby boys born in the United States to reduce the spread of H.I.V., the virus that causes AIDS. The topic will be discussed this week at the CDC's National HIV Prevention Conference in Atlanta. A formal draft of the proposed recommendations is due from the CDC by the end of the year.

Insurers are talking up a proposal backed by Partnership for Prevention that was successfully added to the House version of the health reform bill. Gannett's Maureen Groppe cited the amendment, sponsored by Rep. Lois Capps, D-Calif., in a story about "a move by Democrats to replace references to “health-care reform” with references to “health-insurance reform.”

"Dallas Salisbury, head of the Employee Benefit Research Institute, said a proposal to eliminate copays for preventive and wellness care could have the biggest impact on individual behavior," Groppe writes.

“'Employers and insurers that have experimented with this, at the point that they eliminate those copays, they do get dramatic increases in the number of employees that use the services,' Salisbury said.

"The Partnership for Prevention estimates that only 67 percent of women 40 and older get screened for breast cancer. An additional 3,700 lives could be saved each year if 90 percent did, according to the organization, which wants Congress to remove deductibles and copays for preventive services.

“'The main purpose of cost-sharing is to discourage the use of medical services,' said Robert J. Gould, the group’s president. 'But clinical preventive services are currently underutilized.'"

The Hartman Group, a market research firm that specializes in studying how consumer attitudes and behaviors lead to purchase, says the ideal solutions to the obesity dilemma "may have little at all to do with individual people—and personal responsibility—and a heck of a lot more to do with the larger cultural framework within which we live our lives."

"You’ve heard this from us before, but it bears repeating again and again, until it is clearly understood," the group says in an article in its HartBeat online newsletter. "We believe significant shifts in important dimensions of our eating culture (e.g., increased snacking frequency, the tendency toward eating alone, and the shifts in eating occasions) have contributed to much of our health and obesity problems."

"...And herein, once again, lies the most significant and important challenge of all, namely, how to change not individual behavior, but the parameters within which such behavior resides—how to change our culture."

Meanwhile, Hartman says increased knowledge and education regarding matters of health, weight and diet "appear to have little impact on one’s own health and weight."

"While we’ve all watched the value of helpful educational information designed to aid the individual consumer skyrocket, we’ve also seen a related rise in obesity rates," the group says. "Strangely, government programs continue to produce ever-more elaborate informative brochures and educational materials, as if somehow these were going to magically begin producing results."

Do you need an incentive to help you live a healthier lifestyle? If so, you can "blackmail yourself" at www.StickK.com, a web site where you can create a contract to give away money to a person or charity if you don't make a pre-determined lifestyle goal.

Yale economist Dean Karlan is one of the co-creators of the site. Karlan says incentives help many people by "raising the price of vice and lowering the price of virtue."

Independent grocer Rouses Markets has teamed up with Ochsner Health System to launch "Choose Healthy," a community initiative program in Louisiana that aims to raise public awareness about obesity and the benefits of smart food and lifestyle choices. Rouses stores will feature Ochsner-endorsed eating recommendations and offer free health screenings, educational programs and cooking demonstrations to customers as part of the campaign.

Earlier this year, Congress had proposed spending between $3 billion and $10 billion on prevention and wellness programs when it initially crafted an economic stimulus bill. But when key senators insisted the overall price tag for the legislation had to fall below $900 billion, prevention's share was zeroed out by Congress before the White House intervened to insist on $1 billion.

Fast-forward to August and remarks made by Senate Finance Committee Chair Max Baucus, D-Mont., as health reform negotiators work to achieve a bipartisan bill.

As the Washington Post explains: "Before leaving for the month-long recess, Baucus had pegged the cost of the negotiators' ideas at less than $900 billion over the next decade. Thursday's discussions focused on driving that cost lower, the sources said."

The House version of the bill contained provisions requiring first-dollar coverage for many clinical preventive services, and establishes a trust fund reserved for prevention and wellness programs. Many observers fear such programs will be deemed "expendable," particuarly in light of Congressional Budget Office statements that prevention programs do not save money for the federal government.

Is it deja vu all over again?

Whole Foods CEO John Mackey garnered a lot of attention with a recent Wall Street Journal column in which he opposed health reform legislation in favor of increased "personal responsibility." The column drew an interesting rebuttal from Dr. Rahul Parikh, a pediatrician in the San Francisco Bay Area and a frequent contributor to Salon.com and The Health Care Blog.

Parikh says Mackey's view, while widely shared, "doesn’t take into account the socio-economic factors that pressure many Americans into chronic illness." He said that reality was impressed upon him by a recent trip to the supermarket in which he set a budget of $40.

"I spent half of that money on fresh, healthy foods and the other half on processed foods," Parikh says. "I took my grocery bags home and counted up the calories per d ollar that I spent on both types of foods. For the healthier choices, I got 140 Calories per dollar; for the processed foods, I got 370 Calories per dollar. "

"...Add the consequences of my little experiment to some other factors, like the lack of access to fresh foods in poorer communities (Mr. Mackey, do you have any stores in low-income areas?), or a lack of safe places to get out and exercise, and you can see that prevention has as much to do with class, income, and communities as it does with personal responsibility," the doctor concludes.

U.S. life expectancy has risen to a new high, now standing at nearly 78 years, the government reported Wednesday. The increase is due mainly to falling death rates in almost all the leading causes of death. The average life expectancy for babies born in 2007 is nearly three months greater than for children born in 2006.

The death rate from heart disease dropped nearly 5 percent in 2007, and the cancer death rate fell nearly 2 percent, according to the report. The HIV death rate dropped 10 percent, the biggest one-year decline in 10 years. The diabetes death rate fell about 4 percent, allowing Alzheimer's disease to surpass diabetes to become the sixth leading cause of death.

A project that links Medicare payments to quality of hospital care has led to the prevention of 4,700 heart attack deaths in four years, according to an analysis by the contractor, Premier Financial Services.

The Centers for Medicare and Medicaid Services (CMS) announced fourth-year data from its hospital quality improvement project as well as data from two demonstration projects in which physician groups improved outcomes by following quality measures.

The new CMS data provides support for what President Obama and others have proposed -- paying for improvements in patient health, rather than for the number of services received during a hospital stay. Proponents of the so-called value-based purchasing concept say the plan could help save major money in the Medicare system.

The Convergence Partnership, a collaboration of six of the country's top health foundation, has issued a joint statement (3 pages, PDF) from the leaders of those foundations calling for prevention measures to be central to the reform of our national health system.

Top officials at the California Endowment, Nemours, Kaiser Permanente, and the Robert Wood Johnson, Kresge, and W.K. Kellogg foundations wrote that prevention measures such as early health screenings and improved access to healthy food will save both lives and money. As Congress debates how to reform the system, the foundation leaders emphasize that prevention can save money and improve the long-term health of the population.

A 2008 study by the Trust for America's Health, Prevention for a Healthier America (72 pages, PDF) found that for every dollar invested in proven community-based disease prevention programs, the nation saves $5.60. According to the study, investing $10 in prevention per person would yield annual savings of more than $16 billion nationwide within five years.

"Over time," the signatories wrote, "a focus on community prevention will improve health, save money, reduce demands on our health system, and, most important, lead to a nation of healthier people and healthier places to live."

The question of why prevention doesn't save money continues to dominate media coverage of health reform issues as they relate to disease prevention and health promotion. The most recent example was Michelle Andrews, who wrote a piece entitled "The Problem with Prevention" for The New York Times' online "Prescriptions" page. The "problem" is, of course, is that experts say prevention won't save as money, contrary to claims made by President Obama and others.

Partnership President Rob Gould was interviewed for the piece, and he cautioned that value, not savings, is the proper question for consideration.

"The key is to invest in measures that provide the most bang for the prevention buck — high clinical value at a reasonable cost," Andrews writes. 'The right question to ask is whether it’s a cost-effective use of health dollars,' said Rob Gould, president of the Partnership for Prevention, a nonprofit that promotes preventive health.

"Judged this way, certain preventive services, but not all, may be considered worthwhile, in that while they may not save money, their cost is considered reasonable for the years of sickness and the deaths that they help people avoid," Andrews says. "By those criteria, effective prevention includes colorectal cancer screening for adults ages 50 and older, adult flu shots and screening for high blood pressure in appropriate patients."

But Andrews also notes that even those services may run afoul of the Congressional Budget Office scoring that holds that "the lower mortality rates that result … could increase federal spending for Social Security and Medicare.”

This prompted the following response from one reader: "I’m waiting with bated breath for the stunning argument... that the cheapest way of all is to have NO health care system."

Harold Goldstein, executive director of the California Center for Public Health Advocacy, recently analyzed the strategy that produced staggering levels of obesity in the United States.

“We put fast food on every corner, we put junk food in schools, we got rid of PE, we put candy and soda at the checkout stand of every retail outlet you can think of,” he said. “The results are in. It worked.”

Sales of moist snuff have doubled since the 1980s, and many smokeless tobacco users mistakenly believe the products are less hazardous to their health because they do not expose the user to tobacco smoke. But a new study presented at a recent meeting of the American Chemical Society, shows some of the most popular smokeless tobacco and snuff brands contain an additional 21 smoke-related polycyclic aromatic hydrocarbons (PAH), which are potent toxins and carcinogens.

"This study once again clearly shows us that smokeless tobacco is not safe," researcher Irina Stepanov, PhD, of the University of Minnesota at Minneapolis, says in a news release. "Our finding places snuff on the same list of major sources of exposure to polycyclic aromatic hydrocarbons as smoking cigarettes."

Until recently, researchers thought smokeless tobacco contained only trace amounts of PAH because the tobacco was not burned when used.

A “transportation prescription” for health was named Partnership for Prevention's "Best Prevention Idea of the Week," while the ouster of a Florida public health doctor for criticizing doughnuts on his office sign was named “Worst Prevention Idea of the Week.”

The Best/Worst Idea awards are a regular feature of Prevention Matters, the blog of Partnership for Prevention. 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.



BEST

“Transportation Prescription” for Health Outlined
http://www.convergencepartnership.org/atf/cf/%7B245a9b44-6ded-4abd-a392-ae583809e350%7D/TRANSPORTATIONRX.PDF

The Convergence Partnership has commissioned a new report by PolicyLink and Prevention Institute entitled The Transportation Prescription: Bold New Ideas for Healthy, Equitable Transportation Reform in America. It's a guide to how healthy, equitable transportation policies can improve the quality of life for everyone, and in particular for vulnerable communities. The report presents a collection of policies and programs that can improve health and transportation in underserved communities while simultaneously creating economic opportunities.


WORST

Public Health Doctor “Dunked” over Anti-Doughnut Message
http://www.cbsnews.com/stories/2009/08/13/national/main5240179.shtml

Jason Newsom, a public health doctor in Bay County, Florida, was forced to step down after running messages on an electronic sign outside the health department where he worked that included messages such as “Donuts = Diabetes” and “America Dies on Dunkin.” With the backing of a county commissioner who owns a doughnut shop, two lawyers who own a new Dunkin' Donuts on Panama City Beach threatened to sue. Newsom’s bosses at the Florida Health Department made him remove the anti-fried dough rants and eventually forced him to resign. “I think he was somewhat of a zealot,” the county commissioner with the doughnut shop told the Associated Press.

Jason Newsom, a public health doctor in Bay County, Florida, was forced to step down after running messages on an electronic sign outside the health department where he worked that included messages such as “Donuts = Diabetes” and “America Dies on Dunkin.”

With the backing of a county commissioner who owns a doughnut shop, two lawyers who own a new Dunkin' Donuts on Panama City threatened to sue. Newsom’s bosses at the Florida Health Department made him remove the messages and eventually forced him to resign. “I think he was somewhat of a zealot,” the county commissioner with the doughnut shop told the Associated Press.

Business executive David Goldhill writes a passionate piece in the current edition of The Atlantic entitled "How American Health Care Killed My Father." Goldhill, whose father died of a hospital-borne infection at New York City institution, says the perverse sets of incentives within the current system aren't worth keeping.

"Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results," Goldhill writes. "Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that—most important—remove consumers from our irreplaceable role as the ultimate ensurer of value."

Goldhill recalls Dr. Peter Pronovost 's attempts to reduce the incidence of fatal hospital-borne infections by using a simple checklist of ICU protocols governing physician hand-washing and other basic sterilization procedures.

"Hospitals implementing Pronovost’s checklist had enjoyed almost instantaneous success, reducing hospital-infection rates by two-thirds within the first three months of its adoption," he said. "But many physicians rejected the checklist as an unnecessary and belittling bureaucratic intrusion, and many hospital executives were reluctant to push it on them.

"My dad became a statistic—merely one of the roughly 100,000 Americans whose deaths are caused or influenced by infections picked up in hospitals," Goldhill says.

"How was it possible that Pronovost needed to beg hospitals to adopt an essentially cost-free idea that saved so many lives? Here’s an industry that loudly protests the high cost of liability insurance and the injustice of our tort system and yet needs extensive lobbying to embrace a simple technique to save up to 100,000 people."

Charles Krauthammer wrote a column this week slamming President Obama's claims that prevention would save money as part of health reform legislation. That column drew a response from Fred Goldstein, President of U.S. Preventive Medicine and a member of Partnership for Prevention. Goldstein sent the following letter to Krauthammer with a copy to House Minority Leader John Boehner, R-Ohio:

Dr. Krauthammer,

I read your piece on Prevention and, while the CBO did in fact state that Prevention as defined in the various bills and analyzed by them did not save money, in fact there were portions of the report that pointed to ways to do it. That was their short line or two regarding behavior change.

As the Milken Institute study "An Unhealthy America: The Economic Burden of Chronic Disease" (October 2007) points out, changing behavior is the key to how prevention saves money. Not the medical prevention approach as studied in the CBO report, which consisted of screenings and medical interventions. Prevention is much broader, and that is the problem with much of what is in the reform bills and why the CBO report says it won't save money.

Prevention consists of Primary, Secondary and Tertiary prevention. Primary Prevention includes things such as seat belts, eat right, get your exercise get immunized. Secondary Prevention is the early detection of those at risk or who have a condition they are unaware of and Tertiary Prevention is managing those that already have a chronic disease such as diabetes. What the CBO looked at, and what people keep pushing in these bills, is secondary prevention (lots of testing) with subsequent medical interventions. They did not look at primary and tertiary prevention where behavior change is critical.

The Milken study found that if we implemented a comprehensive prevention program for 7 preventable conditions including things such as obesity, diabetes, some cancers, etc. the economic impact on the country would be $1.2 trillion annually in medical cost savings and improved work force productivity by 2023.

Another recent study found that between 2001 and 2006, about 50% of the cost increase in health care was attributed to obesity (Health Affairs). If we reverse the obesity trend, we will reverse a portion of this increase. The United States is experiencing an explosion of preventable chronic diseases, obesity being just one. If we reverse each of these trends for these conditions we can lower the growing rate of health care cost increases.

But the CBO is correct it's not so much about the current medical model and how it delivers preventable services; that model does not save money. It's about how we set up comprehensive prevention programs to change behavior, which we as a private company are doing around the country and soon around the world. Companies such as Aon, the largest benefits consulting company in the world, have put The Prevention Plan in for their employees, and in an industry first we are offering this product direct to consumers.

You can get more information at www.USPreventiveMedicine.com and www.ThePreventionPlan.com. Governor Tommy Thompson, former HHS Secretary, is our National Policy Advisor. I would appreciate the opportunity to discuss this with you further.

Frederic S. Goldstein, President
U.S. Preventive Medicine, Inc.

Recent commentary in the Journal of the American Medical Association (JAMA) highlights U.S. progress on addressing the disease and death caused by tobacco products, but notes that significant unfinished business remains. The article underscores the critical and unmet need for greater availability of cessation treatments, higher cigarette taxes and expanded smoke-free policies.

While we can feel good about the decline in the prevalence of smoking and the recent congressional action to give the U.S Food and Drug Administration (FDA) authority over tobacco products (finally), complacence has no place in the tobacco control world.

As the article states, “[s]moking cessation is critical for reducing the tragic and predicable burden of disease caused by smoking.” Tragically, although cessation is a medical treatment with proven efficacy, it remains woefully underfunded and underutilized. The major problem is lack of coverage in private insurance plans and employer-provided health benefits. Barriers, like co-pays and arbitrary limits on cessation treatments, further restrict access and affect quitting success. To address these obstacles, Partnership for Prevention convened the National Working Group for ACTTION (Access to Cessation Treatment of Tobacco in Our Nation), which seeks to change this dynamic by promoting collaboration among health providers, business, insurers and the tobacco control community to implement strategies to increase access and utilization of tobacco cessation treatments.

The JAMA Commentary states the obvious…the recently-enacted law giving FDA authority over tobacco products “represents a critical step in tobacco control.” While the FDA law won’t solve all tobacco control issues, it provides a tremendous opportunity to rein in a rogue industry and to communicate more truthful information to the public about tobacco products. But FDA is not authorized to mandate an expansion in insurance coverage, develop new therapies to help youth seeking to quit or provide workplace incentives that encourage cessation. That important work requires our continue vigilance and advocacy…especially with Congress as they debate health reform.

Be warned. We advocates of tobacco control must stay on high alert for actions that would undermine current tobacco prevention and cessation efforts. There will continue to be a need to demand attention and sufficient resources from government (state and federal) to reduce further tobacco product consumption and to provide those who want to quit with real, comprehensive support and effective treatments to do so.


Diane Canova
Managing Senior Fellow

A USA TODAY analysis of U.S. Census data from 2005 to 2007 suggests that an American school nurse cares, on average, for 971 students. In 13 states, the ratio is more than 2,000 to 1. That falls short of federally recommended standards. It also could leave some schools ill-equipped to deal with the swine flu epidemic when their doors open this fall.

Colorectal cancer patients who took aspirin had a much better chance of surviving than non-users, even after being diagnosed, according to a new study. The study, written by researchers from Harvard Medical School, Massachusetts General Hospital and the Dana-Farber Cancer Institute, is being published in this week’s Journal of the American Medical Association. An abstract is available online.

"The improvements in outcomes were striking," wrote The New York Times' Roni Caryn Rabin. "Patients with colorectal cancer who regularly used aspirin before and after a diagnosis were almost one-third less likely to die of the disease than non-users. Patients who initiated aspirin use only after a diagnosis did even better and had half the risk of dying from the cancer, possibly because of differences in their tumors."

The patients were all being treated for nonmetastatic, or localized, cancers, and were followed for almost 12 years on average.

Former HEW Secretary Joseph Califano says prevention is the "only sure way" to bend the cost curve when it comes to health care expenditures.

"The overarching history lesson is this: the only sure way to bend the curve and curb the rate of increase in health care costs is to keep people out of the sick care system, to put as much profit in prevention as there is in acute care, and to put financial gain and pain into how individuals take (or don't take) care of themselves," Califano said in a column for Kaiser Health News.

Califano offered a number of suggestions along these lines:

• Pay doctors to talk to patients instead of just testing, sticking, cutting and prescribing pills for them. "Brief interventions have been shown to reduce smoking, excessive drinking and eating, couch potatoing and other bad habits that drive up treatment costs," he said.
• Require all insurers to pay for preventive services like regular physical exams and to cover things such as flu and pneumonia vaccinations (as Medicare does). "Then let patients who fail to get such vaccinations and get the disease pay the related sick care costs."
• Sharply increase alcohol and tobacco taxes. "Almost thirty percent of health care spending is attributable to smoking and excessive drinking. Making alcohol and cigarettes more expensive has been shown to reduce both. (Moreover, presently such taxes are woefully inadequate: for every dollar we collect in tobacco and alcohol tax revenues, we spend about nine dollars in health care and other costs.) "
• To reduce unnecessary expensive diagnostic tests and treatments, enact tort reform. "Today the cheapest malpractice insurance for a physician is the MRI, PET or CAT scan."
• Mount a saturation public health campaign. "There was a time when seat belts were for sissies, smoking was chic and AIDS was a social curse. Now every driver buckles up, smoking has been cut in half, and AIDS is recognized as a preventable disease. We can do the same with excessive drinking and obesity."

Schools in the District of Columbia will offer testing for sexually transmitted diseases to all high school students in the coming school year. The move amounts to an expansion of a pilot program conducted last year at eight high schools found that 13 percent of about 3,000 students tested positive for an STD. About 12,000 students attend public high schools in the District.

The Robert Wood Johnson Foundation's James Marks challenges the Congressional Budget Office's scoring rules in a column appearing in The Huffington Post. Because those rules exclude any returns on health investments that occur after 10 years, the CBO attributes no budget savings to early childhood inteventions and investments in early detection and prevention -- all of which generally show gains well beyond the 10-year window.

"Benjamin Franklin once famously remarked, 'An ounce of prevention is worth a pound of cure,' Marks wrote. "Unfortunately, what this means is often, according to the CBO, an ounce of prevention isn't worth anything at all."

"...as a doctor, and more specifically, a pediatrician, I know these truths to be self-evident: a society that fails to invest in its children will not flourish, and merely scoring costs in the short term and not determining the value of health in the long term has helped us have the most expensive medical care in the world with a shorter life span than all our competitors," he said.

Can a person's health be improved outside of the doctor's office or hospital? Some Republican lawmakers apparently think not.

Rep. Tim Murphy, R-Pa., a psychologist and co-chair of both the Mental Health Caucus and the GOP Doctors Caucus, dismisses proposals to fund infrastructure projects through community prevention measures in the health reform bills being crafted by Congress.

The Chicago Tribune says he "stresses the importance of preventive measures ... (b)ut Murphy thinks infrastructure projects like bike trails would probably best belong in a transportation bill. The health care bill itself, he believes, must address how care can be delivered more effectively and efficiently by doctors and hospitals."

In making such statements, Murphy apparently overlooks the fact that the US Task Force on Community Preventive Services - an independent panel of experts sponsored by the Centers for Disease Control and Prevention - has identified more than 60 policies and programs that are proven to address the nation's most serious preventable health problems, like obesity and smoking. These policies, which are implemented outside of a doctor's office or hospital, help create environments that facilitate good nutrition choices and create safe places and opportunities in which people can engage in physical activity.

A draft Senate bill would provide up to $10 billion annually for a prevention and public health investment fund -- a portion of which could be used for projects such as bike paths, sidewalks, farmers markets and other community interventions meant to curb chronic and costly conditions like obesity.

So let's get this straight - chronic diseases are underlying drivers of our current health care expenditures; many of these chronic disesases can be largely prevented through good nutrition and increased physical activity; good nutrition and increased physical activity can be increased through non-clinical programs; but the health reform bill should only concentrate on things that happen in doctor's offices and hospitals? Hopefully, Rep. Murphy will re-think this stance.

More than 400 Mississippi school nurses will become the first in the nation to be trained by a national association to fight increasing cases of childhood obesity in the state. The nurses will be trained by the National Association of School Nurses through the School Nurse Childhood Obesity Prevention Education today and Wednesday at the Marriott Hotel. The program provides strategies for school nurses to assist students, families and the school community to promote healthy weight.

U.S. health plans "appear to be getting the message" that they should offer free tests to encourage prevention, but they aren't rushing to embrace a proposed government mandate of first-dollar coverage of clinical preventive services.

Phil Galewitz of Kaiser Health News talked to insurance officials to get their take on first-dollar coverage.

"Aetna, one of the nation’s largest insurers, this year began introducing health plans for small employers that charge patients no co-pays for preventive care such as routine physicals, vision and gynecological exams, and well-child visits," Galewitz wrote.

"The company says it is pricing that new plan the same or nearly the same as what the existing plans would have cost, although it has increased co-pays on certain other benefits.

"Aetna spokesman Mohit Ghose on Friday said the company strongly supports efforts to promote prevention in health reform. He declined to say whether the company would support a government mandate eliminating copayments for preventive services.

"America’s Health Insurance Plans, the industry’s top lobbying group, opposes the mandate, said spokesman Robert Zirkelbach. He cited the need to give insurers flexibility in designing benefit packages.

"Wellpoint, the largest Blue Cross and Blue Shield company, said it sees the benefit for waiving cost sharing but doesn’t want the government mandate.

“'Many of WellPoint’s affiliated health plans’ benefits already offer preventive services with no co-pay or deductible as we feel these are important services,' said spokeswoman Cheryl Leamon. 'We also believe it is important for our members and others to have the choice in the type of health plan and benefits that fit their needs.'”

President Obama recently cited "no cost sharing for preventive services" as one of eight protections he wanted a health reform bill to provide.

The bills currently working their way through Senate and House committees all mandate Medicaid coverage of clinical preventive services. The House Energy and Commerce Committee last week approved an amendment by Rep. Lois Capps, D-Calif., that would prohibit cost-sharing for clinical preventive services provided to Medicaid patients.

White House economic advisor Lawrence Summers says Congressional Budget Office's failure to atttribute savings to prevention programs means health care legislation will be even more fiscally responsible than expected.

"It’s what we call a “belt and suspenders” approach," Summers, who chairs the National Economic Council, said on NBC's "Meet the Press."

"There are some things - how we pay drug companies, for example - where you can do the accouinting very accurately and see what happens to the deficit," he said. "There are other things - encouraging preventive care, taking the whole reimburseement system out of politics - where it’s much more difficult to do the exact calculation. And so the CBO doesn’t give us any credit for them, although most people would say that over time they’re likely to have some benefit.

"We’re doing both sets of things," he continued. "And so I think we’ve got a lot a lot of basis for being optimistic that whatever the CBO says it’s going to end up better. This is the most fiscally responsible approach to introducing a major structural change in the economy that’s ever been pursued. And it’s right, because the center has got to be containing health care costs or it’s not going to work for most families."