Prevention Matters

In a page one story in yesterday’s Washington Post entitled, “FDA plans to limit amount of salt allowed in processed foods for health reason," reporter Lyndsey Layton writes:

“The Food and Drug Administration is planning an unprecedented effort to gradually reduce the salt consumed each day by Americans, saying that less sodium in everything from soup to nuts would prevent thousands of deaths from hypertension and heart disease. The initiative, to be launched this year, would eventually lead to the first legal limits on the amount of salt allowed in food products.

The FDA’s involvement is welcome news. For years public health authorities have cautioned Americans to reduce sodium consumption in order to reduce the risk of heart disease and stroke; the nation’s first and third leading causes of death. In fact, according to the Centers for Disease Control and Prevention, 69% of adults in the United States are at “especially high risk for health problems from consuming too much sodium.” You are considered high risk if you are over 40 years of age, African American or have high blood pressure.

But following advice to reduce sodium consumption is tough work. 77 percent of sodium in our diets come from processed and restaurant foods. According to the WPost story the FDA is planning to “analyze the salt in spaghetti sauces, breads and thousands of other products” and (work) “with food manufacturers” to set limits for salt that would be “designed to gradually ratchet down sodium consumption. The changes would be calibrated so that consumers barely notice the modification.” (emphasis added)

A few hours after publication of the story, the Institute of Medicine lifted a media embargo and went public with their much anticipated report “Strategies to Reduce Sodium Intake in the United States.” The report confirms that despite multiple “voluntary efforts to reduce sodium consumption in the United States during the past 40 years, they have not succeeded.”

Much is at stake. According to the IOM, “population-wide reductions in sodium could prevent more than 100,000 deaths annually.”

The heart of the IOM recommendation is a regulatory strategy similar to the approach the Washington Post indicated the FDA was considering. They recommend “the FDA set mandatory national standards for the sodium content in foods – not banning outright the addition of salt to foods but beginning the process of reducing excess sodium in processed foods and menu items to a safer level.” The report emphasized: “It is important that the reduction in sodium content … be carried out gradually, with small reductions instituted regularly as part of a carefully monitored process.”

And good news for food gourmands. The report notes “evidence shows that a decrease in sodium can be accomplished successfully without affecting consumer enjoyment of food products IF IT IS DONE (emphasis added) in a stepwise process that systematically and gradually lowers sodium levels across the food supply.”

On Thursday, April 22,  Partnership will host a briefing (“Reducing Sodium Consumption: Is it time?") on Capitol Hill with the Congressional Prevention Caucus to hear more about the adverse health effects of excessive sodium in the diet. Caucus Co-Chair, Representative Jim Moran (D. VA) will open the briefing which will be moderated by Partnership’s President Rob Gould. The briefing will include presentations by:

• Darwin Labarthe, MD, MPH, PhD, Director, Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention
• Thomas Farley, MD, MPH, Commissioner, New York City Department of Health and Mental Hygiene
• Mark Broadhurst, Director, Corporate Affairs and State Public Policy, Mars Food US
• Suzanne Hughes, RN, MSN, Preventive Cardiovascular Nurses Association

In the wake of the recent controversy over the US Preventive Services Task Force's recommendations on mammograms, the Washington Post has reprinted a piece issued earlier this year by the folks at Consumer Reports where they list several other common screening services it says the task force has deemed unnecessary "for healthy or average-risk people."

The exams listed have been given a D rating by the task force, meaning that they failed to meet the group's standards. "Many of those tests should be limited to people who have symptoms or risk factors for specific conditions," Consumer Reports said.

Healthy-lifestyle discounts "are critical to health reform and must become the norm for health insurance,” Sami Beg, associate medical director of U.S. Preventive Medicine, said in a letter to The Washington Post.

Beg expressed support for rewarding “people who adopt healthy behaviors, such as enrolling in smoking cessation or nutrition classes and participating in physical activities that lead to healthier weight over time.”

The Washington Post's Rob Stein writes: "Doctors, nurses and other health-care workers in Indiana and Tennessee will receive the first doses of swine flu vaccine Monday as the federal government launches the most ambitious vaccination campaign in U.S. history."

The campaign's goal is to inoculate at least half the U.S. population against the new H1N1 virus. The federal government has spent $2 billion to purchase about 250 million doses of vaccine and has pledged to buy enough to immunize every American if there is enough demand. But public opinion surveys indicate that Americans are undecided about the vaccine.

 

Soda taxes have been in the news a lot lately. On one side are public health experts who say that soda taxes could address our nation’s obesity problem. They cite the success tobacco taxes have had in reducing smoking rates and the relationship between soda consumption and body weight. An article in this month’s issue of the New England Journal of Medicine touts the health and economic benefits of taxing sugary drinks. The Institute of Medicine also recently released recommendations for local governments to combat childhood obesity that include implementing taxes to discourage consumption of foods with minimal nutritional value, which certainly include sugar-sweetened beverages.


Such taxes are also being discussed by policymakers. San Francisco’s mayor announced plans to introduce legislation this fall that will impose a fee on retailers selling sugary drinks, including soda. And President Obama was quoted as saying that soda taxes need to “be explored” as a way to reduce childhood obesity.

Not surprisingly, these proposed taxes are facing fierce opposition. This past Sunday’s Washington Post contains an opinion piece dispelling the 5 “myths” about soda taxes. Coca Cola’s CEO has weighed in on the issue calling a soda tax “socialist.” And anyone who reads a Sunday newspaper has surely seen the full-page ads run by Americans Against Food Taxes (aka, the beverage industry).

Opponents say that recent tax proposals aren’t large enough to impact obesity. That might be true, but they are missing the point. Drinking fewer sugary drinks has no downside (except possibly to the reduced profits of the beverage industry). These drinks push out healthier options like low-fat milk or water, and flood the body with excess calories that are rarely burned off and increase blood sugar levels. Teens consume the most soda and other sugary drinks, and are also historically price sensitive. Limiting their consumption of sugary drinks would cut their risk for obesity, diabetes, and cardiovascular disease, all costly health problems. And with states cutting essential programs and services, they should be looking to increase revenue wherever possible. Soda taxes seem like a win-win situation.


Alyson Hazen Kristensen, MPH

Senior Fellow & Program Officer
Partnership for Prevention

The Washington Post printed the following letter from Partnership President/CEO Robert J. Gould in its Sept. 8 edition:

"It's bad enough that in the debate over health reform, the media's only interest regarding disease prevention and health promotion seems to revolve around the question of whether prevention will save enough money to pay for the health-reform bill. But the Sept. 1 news story "Study Raises Questions About Cost Savings From Preventive Care" seemed to go further by implying that the country should fund highly effective programs for controlling diabetes only if they save money.

"The fact is, while some preventive measures save money, almost all of them provide real value in that they offer more health benefits per dollar spent than many medical treatments do. While this may not pay the freight for health reform, it will help our country stretch its health-care dollar.

"That is indeed worth something. And, oh yes, prevention measures also help people live longer and healthier lives. Isn't that what our health-care system is supposed to be about?"

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?

Partnership for Prevention Board Member Michael J. Critelli was quoted in a July 26 article in The Washington Post in which he identified prevention as a way to control health care cost drivers.

Atul Gawande, the doctor whose recent New Yorker piece piece comparing the medical systems of El Paso and McAllen, Tex. has caused a major stir in health policy circles, says a greater focus on prevention could help reduce costs in McAllen "overnight."

"...We have not been thinking hard enough about how we control costs and make a better system," in an interview with the Washington Post's Ezra Klein. "I think it's achievable in about 10 to15 years, and maybe even faster. I can tell you three things that will transform McAllen overnight. But CBO doesn't score them."

Gawande said McAllen's average $15,000 annual expenditure per Medicare beneficiary could be reduced to $10,000 through a reduction in home visits, an increase in the use of hospice care vs. ambulance rides, and "work on basic cardiac prevention like getting people statin drugs."

"Most studies have shown you'll lower the cardiovascular disease rate by 25 percent and lower the number of procedures ordered," he said. "This was done in by Kaiser of Northern California, and they became the first community I've ever heard of where heart disease stopped being the leading cause of death."