Prevention Matters

CQ Health Day says the chairman of the Senate Finance Committee is complaining that "health care reform is in jeopardy" unless he can convince the Congressional Budget office to to score savings in the health proposals he’s shown them.

Sen. Max Baucus Baucus, D-MT, said at a hearing Thursday that the legislation would be a tough sell to the public if lawmakers and congressional actuaries can’t deliver on one of President Obama’s key promises — that a health care overhaul would lower spending growth.

“The slight challenge we have is getting numbers and estimates from CBO,” Baucus said. “Otherwise, health care reform is in jeopardy.”

President Obama on Monday named Eric Goosby as the new global AIDS coordinator and administrator of the President's Emergency Plan for AIDS Relief, the New York Times reports.

According to the Times, Goosby likely will be a "lightning rod" if he is confirmed by the Senate because some advocates are hoping to expand the current focus of PEPFAR prevention programs beyond abstinence and fidelity to include things like increased condom distribution and family planning programs. Although Goosby will stipulate some guidelines, other policies were written into law, the Times reports.

Goosby currently serves as CEO and chief medical officer of Pangaea Global AIDS Foundation and is a professor of clinical medicine at the University of California-San Francisco. During the Clinton administration, he served as deputy director of the White House National AIDS Policy Office and director of HHS' Office of HIV/AIDS Policy. According to White House officials, Goosby was a key player in the developing and implementing national HIV/AIDS treatment programs in China, Rwanda, South Africa and Ukraine.

Kas over at The Pump Handle eloquently zings high-profile personalities who are spreading incorrect information about the swine flu epidemic. In particular, he skewers Vice President Joe Biden and televangelist Pat Robertson for their statements about the relative unhealthiness of the air in public transportation systems.

"I would tell members of my family — and I have — I wouldn’t go anywhere in confined places now,” Biden told reporters. As examples of confined places, he mentions planes and subways. White House officials later backtracked from that statement.

Meanwhile, Robertson told "700 Club" viewers that airlines improve fuel efficiency by decreasing the indoor quality of air through its circulation systems. (YouTube clip starts at 3:15).

"Shame on you Joe. Shame on you Pat," says Kas, who identifies himself as an industrial hygienist studying public health in the DC metro area. "You know that your names and your faces are more widely-recognized than any public health official’s name or face. You know that you bear the responsibility to get it right not just because you’ve both gotten it wrong before, but because there are a lot of people out there who still like you and may be inclined to believe at face value what you’re saying."

Mexican police dealing with the swine flu epidemic there have arrested 13 individuals accused of selling surgical masks on the street. This led Health Economist blogger Jason Shafrin to examine the ethics associated with providing free surgical masks.

If the government stayed out of the picture and allowed private enterprise to address the surgical mask situation during an epidemic, "manufacturers of surgical masks would receive the same amount of money, but instead of getting paid by the government, they would be paid by firms," Shafrin says. "Firms would be the winners in that they could resale the masks at a profit. Wealthy and middle class households would be able to purchase the masks and poor families would not."

Another argument for free distribution of surgical masks is to prevent corruption, Shafrin says. "If individuals can sell surgical masks at a profit, government workers will have an incentive to give away surgical masks to their friends," he says. "Their friends can collect rents from their receipt of a large quantity of free masks."

Orange County, California, officials have reversed themselves and agreed to restore funding to Planned Parenthood for sex education. The county supervisors then adopted new policies to restrict funds for health education programs in the future.

In March, supervisors suspended a grant worth nearly $300,000 in tobacco settlement revenue earmarked for sex education because the organization performs abortions. At the urging of county lawyers, they vote April 28 to reinstate the grant, but then voted unanimously to direct the county Health Care Agency to use tobacco settlement revenue at community clinics to direct health services, rather than health education.

The CDC released results from the national Youth Risk Behavioral Study (YRBS) that suggest it may be important to target tobacco cessation counseling to young smokers, where the likelihood of success in quitting is greatest.

The study showed that nearly two-thirds (60.9%) of students who ever smoked cigarettes daily tried to quit smoking cigarettes. However, among those who tried to quit, only 12.2% were successful. While the prevalence of success in quitting did not vary by sex or race/ethnicity, more students in 9th grade (22.9%) than in 10th grade (10.7%), 11th grade (8.8%) and 12th grade (10.0%) were successful at quitting.

The 2008 Public Health Service Guidelines – Treating Tobacco Use and Dependence agree that counseling has been shown to be effective in treating adolescent smokers, and recommend that adolescent smokers be provided with counseling interventions to help them quit smoking.

These findings also reinforce the need to fully implement and sustain comprehensive tobacco prevention and control programs that increase excise taxes, promote smoke-free air policies, and conduct media campaigns in conjunction with other community-based interventions, such as tobacco-use prevention programs in schools that include school policy and education components. These proven interventions are effective in reducing smoking among youth and adults.

Diane M. Canova
Managing Senior Fellow and Senior Program Officer

Former Health and Human Services Secretary Tommy Thompson says lifestyle-oriented prevention initiatives could help control future health care costs.

"Will health reform require an upfront investment? Yes. But will that investment pay off in the long term? Yes, it will," Thompson says in a column appearing in Politico.

He expresses concerns that the Congressional Budget Office's estimated price tag for a health reform bill "will not capture the future savings, because it underestimates the value of investment in health care as a means to achieving a healthier, more productive and, ultimately, more prosperous America. "

"While not all prevention and disease management programs are cost-saving, especially in the short term, reliable research indicates that if we can get Americans to lead healthier, more active lives and proactively manage their health, we can help control the cost of health care by delaying — and in some cases fully avoiding — costly chronic health problems," he adds.

Tommy G. Thompson is a partner at Akin Gump Strauss Hauer and Feld, former four-term governor of Wisconsin, former secretary of the Department of Health and Human Services and co-chairman of the Wisconsin chapter of the Partnership to Fight Chronic Disease.