Prevention Matters

The Associated Press (“Obama has kicked smoking habit, first lady says”) reported earlier this week that President Obama had “given up smoking.” The source for the report wasn’t the White House Press office but First Lady Michelle Obama. Mrs. Obama confirmed that the President had successfully quit smoking and had been smokefree “almost a year.”

This is wonderful news for the Obama family and for millions of Americans who struggle to quit smoking and wonder if they will ever be successful.

The President’s success sends an unmistakable message of hope to those struggling to quit. Now children whose parents smoke can refer to the President’s example and his struggle. Quitting is possible…even if you are President of the United States.

In a recent meeting of Partnership’s ActionToQuit state grantees, the news from Mrs. Obama was greeted with much excitement and admiration. In a letter of congratulations to the President these state tobacco cessation leaders wrote: “Your experience in quitting smoking gives hope to millions who struggle with their (tobacco) addiction. Your example – that quitting … is possible with the right combination of therapy and family support will encourage others to make the effort and realize the success, even in one of the world’s most stressful jobs.”

The ActionToQuit members joined Partnership VP Diane Canova in urging the President to take pride in his accomplishment and “consider sharing your experience to help other smokers seek out the smoke-free pathway to a longer, healthier life.”

The President’s experience with quitting tobacco is all too human. Quitting takes time. His example demonstrates perseverance and should encourage all of us to redoubling our efforts to expand access to tobacco cessation and encourage the types of social and family supports that increase smoking cessation success. The Affordable Care Act expands access to tobacco cessation through health insurance plans including Medicare and Medicaid. The new Prevention and Public Health Fund will make financial assistance available to help communities promote health and wellness including preventing and reducing tobacco use. These are important tools that can accelerate progress towards a healthier, smokefree nation.

But let’s not underestimate the important motivational role that examples of successful quitters can play. We hope the President’s struggle and his success will motivate others to successfully quit.

• Require Internet sellers to pay all federal, state, local or Tribal tobacco taxes and affix tax stamps before delivery to any customer;
• Mandate that the age and identification of purchasers be checked at purchase and at delivery
• Require Internet vendors to comply with state and local laws as if they were located in the same state as their customers;
• Provide federal and state enforcement officials with new tools to block delivery of cigarettes and smokeless tobacco products that evade federal or state laws; and
• Ban the delivery of tobacco products through the U.S. mail. 

The passage of a health reform bill that emphasizes prevention and wellness was named the “Best Prevention Idea of the Week,” while reduced life expectancy due to preventable risk factors was named the “Worst Prevention Idea of the Week."

The “Best/Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. Nominees are submitted by Partnership staff as well as the general public, and are voted on by the staff. Partnership for Prevention is a nonpartisan organization of business, nonprofit and government leaders who are working to make evidence-based disease prevention and health promotion a national priority. More information is available at http://www.prevent.org/.

BEST

Obama Signs Historic Health Reform Law, Steps Up Focus on Prevention and Wellness

On March 23, 2010, President Barack Obama signed the health care bill into law. The new federal health reform law (HR 3590) includes many provisions aimed at disease prevention and promoting healthy lifestyles. The law creates a $15 billion fund for programs designed to promote prevention and wellness, such as efforts to address obesity and to help patients manage chronic diseases. The law also establishes a National Prevention, Health Promotion and Public Health Council to coordinate federal efforts to promote healthy living. In addition, the health care reform law:

• Eliminates copayments for Medicare and Medicaid beneficiaries receiving preventive services;
• Increases reimbursement rates for physicians who offer certain preventive services;
• Provides grants to small business for establishing wellness programs and incentives for employers to offer workers as much as 50% off their premiums for participating in such programs; and
• Requires chain restaurants and vending machines to disclose nutritional information.

WORST

Four Preventable Risk Factors Reduce Life Expectancy in U.S. and Lead to Health Disparities

A new study led by researchers from the Harvard School of Public Health (HSPH) in collaboration with researchers from the Institute for Health Metrics and Evaluation at the University of Washington estimates that smoking, high blood pressure, elevated blood glucose and overweight and obesity currently reduce life expectancy in the U.S. by 4.9 years in men and 4.1 years in women. It is the first study to look at the effects of those four preventable risk factors on life expectancy in the whole nation.

In a wide-ranging interview (“Michelle Obama: No longer a 'caricature”) published today in Politico, the First Lady “addressed a doctors’ report that the president is still smoking, saying he has found it difficult to quit amid the rigors of the presidency.”

“What the president struggles with is what every smoker struggles with, it’s a difficult habit to break. It’s understandable that he struggles with it. Do I want him to stop completely? Absolutely. And I will push him to do so, but it’s a process,” Michelle Obama said.

“I’ve never been a smoker so I can’t relate, but people who’ve smoked say like anything, you have dips and valleys, and to try to quit smoking in one of the most stressful times of the nation’s history is sort of like, you know, OK, he’s going to struggle a little bit. This may be the year he’ll struggle,” she said.

We know that quitting smoking is tough work. It takes persistence. That is why Partnership for Prevention and its ACTTION initiative are working to assure that health reform continues to include coverage and access to comprehensive smoking cessation services. But, no less important to successfully quitting, is having the kind of supportive family and workplace environment that is available to the President. I’m not worried about the President. With Michele in his corner he’ll get there.

Posted by:
Ripley Forbes
Director, Government Affairs, Partnership for Prevention

At the recent health summit in Washington, President Obama repeatedly emphasized his commitment to pass meaningful health reform. Despite strong opposition from Republicans in Congress, President Obama is showing the mettle he demonstrated throughout the 2008 campaign. He isn’t giving up and he won’t back down. His commitment to insurance reform and extending high quality health coverage, including access to vital clinical preventive services to millions of uninsured Americans shows courage and character.

But the issue of smoking is one where we value quitters. According to press reports President Obama’s recent physical revealed that he continues to struggle to quit smoking. Most smokers have trouble quitting tobacco so the President’s situation is not unusual. It is ironic that the President who has done so much to protect children from tobacco, and through health reform, increase the availability of tobacco cessation therapies, would struggle to win his personal cessation campaign. But Obama is human and difficulty quitting tobacco is an all too common experience among the millions of smokers who try to quit each year.

Writing in the March 1st Christian Science Monitor, Ron Scherer notes that “anti-smoking advocates view the president’s cigarette struggles not so much as a setback, but rather as an opportunity to try to get more Americans to quit. And they place more importance on his desire to snuff out his tobacco usage than on his success in those efforts.”

Now that’s something we should all be able to agree with. That the President has struggled to quit smoking underscores why it is so important that insurance plans, employers, friends and family members do all they can to support and encourage smokers seeking to quit what is all too often a lifelong and life threatening addiction.

A CBS TV News Healthwatch segment (“Up in Smoke”) added important commentary from medical correspondent and physician Jennifer Ashton. Dr. Ashton cautioned that most former smokers find success only after trying to quit multiple times. She urged that smokers take advantage of available treatments including counseling, OTC nicotine replacement products and prescription medications. Ashton said the decision to quit smoking is really “a life or death issue and the single most important thing you can do for your health.”

Good advice for the public…and for our President.

Posted by:
Ripley Forbes
Director, Government Affairs, Partnership for Prevention

President Obama today released his proposal for resolving the impasse with Congress over health reform. The proposal is summarized in an 11 page document released this morning by the White House. Initially prevention advocates were shocked to discover that the words “prevention” and “wellness” were not included in the summary draft. Fortunately, these concerns were premature as the release of additional information highlighted the key role that prevention plays in the Administration’s plan for reform.

We have since discovered that the 11 page summary was intended primarily to highlight proposed changes in the Senate passed health reform bill; HR 3590, the “Patient Protection and Affordable Care Act.”

The White House has developed a detailed web site which discusses the President’s proposal in greater detail. Most encouraging to those of us who believe REAL Health Reform Starts with Prevention, the President has made crystal clear his Administration’s continued support for the key prevention, public health and wellness provisions contained in Title IV of the Senate passed health reform bill. By retaining the Senate proposal for the prevention trust fund, the proposal “provides for unprecedented investments in prevention, public health, disease research, and screening. The national investment in preventing disease and finding cures will save lives and money in the long run for American families, small businesses, and the Nation.”

The President’s commitment to prevention is reflected in the following description of the Prevention and Public Health provisions of Title IV.

“If we want to truly reform health care to benefit American families, we need to transition from a system focused primarily on treating the sick to one that helps keep people well throughout their lives…It directs the creation of a national prevention and health promotion strategy that incorporates the most effective and achievable methods to improve the health status of Americans and reduce the incidence of preventable illness and disability in the United States. The Act relies on the innovation of small businesses and state and local governments to find the best ways to improve wellness in the workplace and in our communities. And it strengthens America’s capacity to respond to public health emergencies. The Act empowers families by giving them tools to find the best science-based nutrition information, and it makes prevention and screenings a priority by waiving co-payments for America’s seniors on Medicare. By attacking disease before it hits, the Act helps to improve health, save lives, and avoid more costly complications down the road.”

Additional details about the President’s health reform proposal are summarized on a white house web site that has been developed in preparation for the bipartisan health summit scheduled for February 25. The summit will begin at 10am and will be broadcast live at whitehouse.gov/live.

Posted by:
Ripley Forbes
Director, Government Affairs, Partnership for Prevention

Tobacco giant Philip Morris USA, a division of Altria Group (MO), on Friday asked the U.S. Supreme Court to throw out the landmark ruling saying the cigarette industry misled the public about the dangers of smoking. Hours later, the Obama administration asked the court to allow it access to nearly $300 billion in what it calls ill-gotten profits from the industry. The dueling filings are the latest chapter in an epic legal fight that has gone on for more than a decade.

In its filing, Philip Morris asked the court to overturn a massive racketeering verdict that forced the company to change its practices and increase its warnings about the dangers of smoking. Philip Morris argued that, in addition to letting the U.S. "pervert" the racketeering statute, known as RICO, the courts had violated its First Amendment rights.

Posted by:
David Zauche
Managing Senior Fellow & Senior Program Officer, Partnership for Prevention

The chairman of the Senate Health Committee tells The Hill that negotiators from the White House, Senate and House reached a final deal on healthcare reform days before Scott Brown’s victory in Massachusetts. Sen. Tom Harkin, D-Iowa said negotiators had an agreement in hand on Friday, Jan. 15 - four days before Scott Brown's surprise Senate win in Massachusetts turned the debate on its head.

“We had an agreement, with the House, the White House and the Senate," Harkin said. "We sent it to [the Congressional Budget Office] to get scored and then Tuesday happened and we didn’t get it back.”

Brown’s Jan. 19 victory gave Republicans control of 41 seats in the Senate, enough to sustain a GOP filibuster of the healthcare bill. But Harkin told reporters in a Monday telephone conference that health reform legislation is still "very much alive."

He said he has been advocating in recent days for the House to pass the Senate version of the health care bill along with a package of revisions that would be passed through the reconciliation process, which would only require a simple majority in the Senate. Harkin predicted that Democrats would pursue that course in the coming weeks and most likely finish by early March.

That differs from the assessment of White House Chief of Staff Rahm Emmanuel, who Thursday told the New York Times that Democrats would try to act first on job creation, reducing the deficit and imposing tighter regulation on banks before returning to the health measure.

James Pinkerton, Schwartz Senior Fellow at the New America Foundation has pinned a insightful blog noting that “with all the hand-wringing over the details of paying for health care, we’ve lost sight of the fact that any good effort to reform health reform care should actually try to improve the health of Americans.”

His posting takes on critics on the left and right who say prevention doesn’t work or doesn’t save money. Pinkerton rightly sees prevention as an investment that reflects a core purpose of a health care system; to maintain and restore a population to health.

“As Washington debates the minutiae of health care dollars and cents, we’re missing what’s clearly common sense. Better health is a good thing; it would be worth investing in even if it didn’t save money. But it’s clear that lots of prevention efforts have the added bonus that they do save money.”

And Pinkerton credits the science behind his opinion. “The research shows that starting early--like way before someone has advanced diabetes or late-stage lung cancer--is critical not only to the survival of the patient, but also to the biggest monetary savings. Targeting these problems means helping people quit smoking, eat more nutritiously, and get more exercise, which often don’t even involve going to the doctor’s office. The New York Academy of Medicine has identified dozens of low-cost programs around the country that have shown real results in reducing smoking rates, limiting diabetes, improving nutrition, and increasing exercise, which then in turn reduce rates of disease.”

For those of us who believe prevention saves much more than money, Pinkerton’s commentary is a refreshing break from the naysayers who seem, with apologies Oscar Wilde, to know the price of everything but the value of nothing.

Ripley Forbes
Director, Legislative & Policy Advocacy
Partnership for Prevention

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.

Partnership for Prevention today applauded President Obama’s call for a health reform bill that requires no cost-sharing by patients who obtain preventive services.

The preventive services proposal was among eight “core consumer protections” that Obama said would be provided by health reform legislation. He listed the eight protections during a Thursday town hall meeting in Raleigh, N.C. A fact sheet issued by the White House on Thursday said their cost-sharing protections mean that “Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.”

“We applaud the president for seeking this type of protection for patients,” Partnership President Robert J. Gould said. “Proven preventive services will help save lives and reduce the incidence of chronic disease that is a leading driver of spiraling health care costs.

“It makes no sense to seek cost-sharing for preventive services,” Gould said. “The main purpose of cost-sharing is to discourage the use of medical services. But clinical preventive services are currently under-utilized.”

Gould said the president’s stance should strengthen support for an amendment that Partnership is helping members of the House Energy and Commerce Committee to craft that would prohibit cost-sharing for preventive services funded under Medicaid.

A study by Partnership for Prevention’s National Commission on Prevention Priorities found that increased utilization of just five clinical preventive services – daily aspirin use, tobacco cessation counseling, adult pneumococcal immunization, and breast and colon cancer screening – would save an additional 100,000 lives a year, while all five services either save money or are cost-effective.

Partnership for Prevention is a non-profit organization of business, health care and government leaders who are trying to make evidence-based disease prevention and health promotion a national priority.

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The President's Council of Economic Advisers has issued a new jobs report, and it should provide something to think about for those who questioned why funding for health care was included in this year's economic stimulus package.

The report projects the growth of health-related jobs versus all other occupations between 2000 and 2016 . It predicts 12% growth for “other occupations”; 35% growth for “health practitioners”; and 48% growth for “health care support.”

The biggest job growth of any category in the economy will come "not for doctors, nurses, or nursing home workers, but for a broadly defined group called 'other medical services and dentists.'” The report projects that this group, defined as “a broad category including the ever-expanding home health care, outpatient care, and medical and diagnostic laboratories subsectors,” will produce more than 2 million new jobs per year for the group, on average, between 2008 and 2016.

President Obama said today he's "95% cured" of tobacco addiction, but admits to falling off the wagon on occasion.

"I've said before that as a former smoker I constantly struggle with it," the president said at a press conference. "Have I fallen off the wagon sometimes? Yes. Am I a daily smoker, a constant smoker? No." "I would say that I am 95 percent cured, but there are times where, there are times where I mess up," he added.

The president, who this week signed legislation into law giving the Food and Drug Administration the power to regulate tobacco products, said that he does not smoke in front of his kids or the rest of his family, and compared his situation to that of a recovering alcoholic.

"I don't know what to tell you, other than the fact that, you know, like folks who go to A.A., you know, once you've gone down this path, then, you know, it's something you continually struggle with, which is precisely why the legislation we signed was so important, because what we don't want is kids going down that path in the first place," he said.

The House of Representatives today approved the Senate version of a bill to give the FDA broad authority to regulate tobacco products. The 307-97 vote sends the bill to President Obama for signature. Speaking from the White House, Obama said he will sign it, adding that broad bipartisan passage of the bill "truly defines a change in Washington."

The American Medical Association says it will oppose creation of a government-sponsored insurance plan. The opposition of America’s largest physician organization could be a major hurdle for advocates of a public insurance plan. President Obama is scheduled to speak to the 250,000 member group on Monday in Chicago.

CQ reports that President Obama told Democratic members of the two Senate committees in charge of health care legislation that completing an overhaul of health care is “not a luxury” and that the period from now to August is the “make or break period.”

With that in mind, CQ says, Senate Democrats intend to move a single health care bill to the floor within weeks.

White House Budget Director Peter Orszag says prevention programs are one of four steps needed in health reform to produce cheaper, better health care.

"How can we move toward a high-quality, lower-cost system?" Orszag asks in a May 15 Wall Street Journal op-ed. "There are four key steps: 1) health information technology, because we can't improve what we don't measure; 2) more research into what works and what doesn't, so doctors don't recommend treatments that don't improve health; 3) prevention and wellness, so that people do the things that keep them healthy and avoid costs associated with health risks such as smoking and obesity; and 4) changes in financial incentives for providers so that they are incentivized rather than penalized for delivering high-quality care."

Meanwhile, The New Republic's Jonathan Cohn reveals some preliminary cost estimates from the Congressional Budget Office and says, "according to several sources familiar with the estimates, the news isn't quite what Obama and his allies were hoping to hear."

President Obama has proposed adding 404 full-time staff members to work on food inspection at the Food and Drug Administration (FDA). David W.K. Acheson, associate commissioner for foods, told a congressional committee that it would be a “retrograde step for public health” if food inspection responsibility was removed from the FDA. Consumer advocacy groups long have complained that federal government attempts to track and regulate food safety are lacking and dispersed among too many agencies, including both the FDA and the U.S. Department of Agriculture (USDA).

President Obama has named Dr. Thomas Frieden, currently commissioner of the New York City Health Department, to head the Centers for Disease Control and Prevention. Frieden, who will start his new job in June, has run one of the nation's largest public health agencies, in New York, since January 2002. Frieden served at the CDC from 1990 to 2002, at one point investigating issues such as a spread of drug-resistant tuberculosis.

In New York City, Frieden oversaw the implementation of smoke-free laws and rules requiring national restaurant chains to post calorie information on their menu boards. He co-authored an April 30 "Perspective" piece in the New England Journal of Medicine that reviewed the experience of places that have enacted soda taxes. The study showed that every 10% increase in soft drink prices results in a 7.8% drop in consumption. The White House credited Friedman with leading efforts to reduce smoking, increase cancer screening and combat AIDS.

Dr. Rich Besser, who has served as acting CDC director, will stay to run the Office for Terrorism Preparedness and Emergency Response, which he has overseen for four years. Health and Human Services Secretary Kathleen Sebelius and the president both praised Besser for his handling of the H1N1 flu epidemic, which during his interim status spread from 20 known cases inside the United States to 4,298 confirmed or probable cases, but only three deaths.

Three companies that are members of Partnership for Prevention’s "Leading by Example" initiative were among the businesses honored at a White House ceremony for their commitment to aggressive workplace health programs.

Johnson & Johnson CEO William Weldon, Safeway CEO Steve Burd and Pitney Bowes CEO Murray Martin were among a handful of executives praised by President Obama for reining in skyrocketing health care costs through programs designed to make their workforces healthier.

Obama saluted the firms for encouraging their employees to exercise, lose weight and quit smoking—and for offering innovations such as physician house calls aimed at keeping patients out of the emergency room. “All this [is] designed to save taxpayers money, save businesses money and ultimately make the American people healthier and happier [and] make sure we’re getting a bigger bang for our health care dollars,” the president said.

Through the Leading by Example initiative, CEOs who have incorporated new, successful approaches to employee health and productivity share their experiences and knowledge with other CEOs.

The Partnership for Prevention website has more information on programs and initiativces at the three employers.