Prevention Matters

This podcast features an interview with Danny McGoldrick, Vice President for Research at the Campaign for Tobacco-Free Kids. His organization recently teamed up with Partnership for Prevention and the United Health Foundation to launch an initiative aimed at American businesses. At a time of deep economic decline, this team is working to show businesses some proven ways to improve their bottom lines – by adopting tobacco-free policies in the workplace and by supporting tobacco-free policies in their communities. Listen by clicking on the media player below.

President Obama's nomination of Dr. Howard Koh to serve as the Assistant Secretary for Health should get enthusiastic support from the public health and prevention communities.

As Commissioner of Public Health for the Commonwealth of Massachusetts from 1997-2003, Dr. Koh oversaw four public health hospitals and a staff of over 3000 professionals. In this capacity, he emphasized the power of prevention and strengthened the state’s commitment to eliminating health disparities. He was involved in establishing and then overseeing the groundbreaking Massachusetts Tobacco Control Program.

Dr. Koh is currently the Harvey V. Fineberg Professor of the Practice of Public Health, Associate Dean for Public Health Practice, and Director of the Division of Public Health Practice at the Harvard School of Public Health. A major focus of his research has been on community-based strategies to reduce cancer disparities and promote cancer prevention and early detection. As Director of the Harvard School of Public Health Center for Public Health Preparedness (HSPH-CPHP), he has promoted education about bioterrorism, pandemic influenza, and other emerging health threats.

“Howard Koh is a world-renowned expert on public health and cancer, and his tenure as commissioner of public health for the Commonwealth of Massachusetts gives him the hands-on experience needed to address the challenges facing those on the front lines of our private and public health care systems,” said Dr. Corinne G. Husten, interim president of Partnership for Prevention. “Partnership for Prevention enthusiastically supports Dr. Koh’s nomination and we look forward to working with him to make prevention a focal point of efforts to reform our health system.”

Robert Laszewski says l have produced the tremors that could re-open the fault lines along the road to health reform. ast week’s estimates by the CBO on the proposed Obama budget. The CBO said the budget would produce a nearly $9.3 trillion deficit over the next decade and increase budget deficits to more than 4% of GDP each year over the next decade.

"Still stunned from that report, and under immense pressure from moderates in the Democratic party to cut spending, both the House and Senate Budget chairs have made it clear they intend to reduce the Obama budget and see the Congress proceed with health care reform following the pay-go rules.," Laskewski writes. "That would mean any new health care reform spending over the next ten years needs to be offset with either cuts to existing spending or with new revenue."

The Indiana University Center for Health Policy has issued findings from a comprehensive review of existing research about the health and economic impact of smokefree workplace laws. It's designed to clear up some of the confusion created by contradictory studies that flood the offices of lawmakers and policymakers. Among the findings:

• While secondhand smoke has been definitively linked to many kinds of health problems, the most significant health consequence related to secondhand smoke is death
• Smokefree workplace laws do not have a negative economic impact on restaurants and bars
• Smokefree workplaces save employers money.
• Servers, bartenders, dealers and other workers in restaurants, bars and casinos may regularly be exposed to high levels of secondhand smoke.

The recent controversy over the pope's declaration that condoms could make the AIDS epidemic worse, not better, in Africa, prompted RTI Chief Scientist Douglas Kamerow to take a stab at closing the chasm between Catholic orthodoxy and public health science.

"One possible approach to the seemingly irresolvable conflict between condoms and religious dictums might be to separate the disease prevention attributes of condoms from their contraceptive effect," Kamerow, a former assistant surgeon general, writes in BMJ.

"There is precedent for this, at least in the United States: many Catholic hospitals and doctors here prescribe oral contraceptives to women not to prevent pregnancy but instead to prevent heavy, painful periods," he continues. "So it wouldn’t be too much of a stretch to imagine the Catholic church tacitly condoning condom use as part of an overall disease prevention programme to decrease the spread of HIV, even if only within marriages."

Kamerow notes that much of the spread of the AIDS epidemic in Africa occurs within marriage, making the pope's encouragement of abstinence a moot point in such cases.

"If condoms are not available, these women are forced to make the impossible choice between refusing to have sex with their husbands (and risking abuse) or consenting to sex (and risking HIV infection)," he concluded.

Princeton economics professor Uwe E. Reinhardt offers some interesting views in the New York Times' Economix blog about the use of Quality of Additional Life Years as a mechanism to gauge the cost-effectiveness of medical interventions.

"A medical intervention yielding a given number of additional life-years in perfect health makes a greater contribution to human well-being than an intervention that yields the same number of life-years in less-than-perfect health," Reinhardt writes. "QALYs are used to adjust for that difference in a patient’s quality of life."

That would appear to make a case for prevention measures aimed at keeping people healthier throughout the life span.

"Cheap interventions might be immunization for infectious diseases, which might save a large number of QALYs at relatively low cost," he wrote. "...Expensive interventions might involve new biological specialty drugs costing $100,000 or more per treatment that might add only a month or two to a terminally ill person’s life, or even low-cost diagnostic tests that do not detect much illness because they are applied to low-risk populations.

Ultimately, he says, reformers face two vexing questions: "Is there a maximum price per quality-adjusted life year (or life-month or life-day) beyond which society will not buy additional QALYs from the health system?" and "If there is a maximum price, should it be the same for all members of society – rich or poor, prominent or not...?"

Sen. Tom Harkin, D-Iowa, used a White House regional forum on health reform this week to make a strong case for prevention and wellness initiatives and then elaborated on his plans in a meeting with editors for the Des Moines Register.

Harkin, who is helping write wellness portions of the Senate version of the health-reform bill, said at the Iowa forum that the government should provide better foods in schools and should build walking paths to encourage exercise. He also said doctors should be rewarded for keeping their patients well, as opposed to the current system in which they are paid mainly for treating them after they become sick.

In a meeting Monday with Register editors and reporters, Harkin added that he would favor charging higher health-insurance premiums to people who smoke or are obese. Such people also ought to receive help and encouragement to improve their habits, he said: "I think there ought to be both a carrot and stick."

"Harkin brushed aside reports questioning whether wellness programs would provide savings to the system," the Register reported. He acknowledged that his proposals would add some costs, but he predicted savings would start quickly: "'I don't mean in 10 years, I mean in the next two or three years, we'll see this start to decline.'"