When It Comes to Policymaking...

There are many health issues that tend to go ignored and unaddressed in society today. They start off as small issues that could easily be prevented with the right tools and education. However, if the health issues go undetected and untreated, they usually turn into serious and costly health problems. It is unfortunate that only 5% of U.S. health spending goes toward prevention when prevention can significantly reduce future spending on direct medical services. Since the benefits of prevention are long-term, results usually aren't seen immediately. I can see how it might be difficult for policymakers to make that initial investment and allocate more money for prevention. However many of the problems with our health care system are due to the current unbalanced allocation of prevention and medical services. The current 5% is nothing compared to the profound influence preventative medicine could have on the health of Americans if the spending were increased.

In order to decrease health disparities, policymakers need to realize that quality health care in the U.S. is extremely expensive and for much of the population, this is a main barrier. Furthermore, cultural competence is important as well. Many people don't know of the various health services available or don't have the educational tools to access them. In this aspect, prevention plays a huge role in reducing barriers to receiving quality health care.

Prevention vs. Treatment

The U.S. healthcare system has been notorious for allocating funds towards treatment rather than prevention. We rather fix what has already been done rather than halting disease and injury in the first place. We are inclined to cure, medicate, and alleviate pain and illness; we tend not to place attention to health promotion. The flawed U.S. healthcare system's reliance on direct medical treatment fails to uphold the United Nation's vision of what being "healthy" is- which is not merely the absence of disease, it is not merely the cessation of sickness, but instead "healthy" encompasses the mental, physical, spiritual, and emotional well-being of a human. And in order to achieve that state, providers need to shift away from solely prescribing, medicaitng, and treating, they need to focus more on educating the public on overall healthy lifestyles that could prevent sickness and promote overall healthiness.

However, policy makers may not agree to this utopian vision of healthcare service delivery. For instance, I work at the Maternal & Child Adolescent Center at HSC which is a special clinic for HIV positive mothers and their families. I worked for a program within that research center which provided health education risk reduction services to incarcerated youth. The health courses aimed to educate these minors on HIV/STD transmission. The goal of the intervention was to prevent these high risk youth from being infected from HIV/AIDS and STD's. The program is contracted through the CDC as an "HERR"- health education risk reduction" intervention which contrasts "Counseling & Testing" interventions. Due to the fiscal crisis, all funding for HERR contracts were reduced by 9% and policy makers are now moving funds to counseling and testing programs. As a result of this, many public and private HIV/AIDS and STD prevention programs shut down. The defense was that...it's not that prevention is not helping halt the HIV/AIDS epidemic, but that these programs were not identifying HIV positive individuals as much as counseling and testing centers were. But if we allocate more funds towards testing, we can halt the epidemic by finding and treating those people...however the high risk groups for HIV/AIDS and STD's may perpetuate high risk behaviors if there are no preventative services available for them.

Some others reasons why only 5% of medical services is spent on prevention is due to the fact that it is difficult and complex to measure outcomes of preventative interventions and programs. It is tricky to evaluate if preventative programs are successful in healthy behavioral change. So policy makers may favor treatment and curative services since it consists of more hard evidence-based criteria of how people are getting treated, where patients are being seen, what type of services are needed etc. whereas most preventative models aim for long-term behavioral changes which may not be measurable or seen until later.

When It Comes to Policymaking....

Since the beginning of the United States healthcare system, the energy of physicians, nurses and other health professionals has been put into the curing/treatment of disease.  For the most part, it has revolved around the patient experiencing symptoms, the physician making a diagnosis and then continuing with a course of treatment.  Even though there is an abundant amount of time spent researching prevention of illness, this knowledge is not always put to the most effective use.

Yet, it is hard to say that our healthcare system is doing something wrong by spending only 5% of the money on prevention.  If we didn't spend as much as we do on treatment then so many lives would have been lost and our life expectancy as a country would seriously decline.  At least in the near future, it does not seem feasible for our system to begin cutting costs on treatment and placing more on prevention.  This is because preventive efforts will be lost on a population that is unwilling to change their behaviors.  I think the mentality of our country needs to become one of health rather than convenience before moving forward with cutting costs on treatment.

The focus of our policymakers needs to be on making early education of healthy lifestyles mandatory in schools.  There needs to be education given to expecting parents, about adult and child nutrition.  There also needs to be a large focus on removing the so many unhealthy vendors and food choices that exist around the country.  

Overall, I think our money spent at the present time is allotted correctly.  In the future it will probably have to change, but for now, it would be extremely wasteful.

Justice is described as “the fair disbursement of common advantages and the sharing of common burdens” to improve population health and help the disadvantaged (Gostin). This mentality has led to policies focused on providing medical care services. In fact, based on your readings, 95% of US health service spending goes towards direct medical services, but only 5% is invested in prevention. Is this the best approach? What do you think policymakers should focus on to reduce health disparities?

I wouldn't plan to spend these large amount of money to come to USC and study public health if my goal is not to reduce the disaprities that we have in the United States. Today's fast speed society, people have no patience to wait and see a 10 - 20 year of studies about something that might not be proven. It is easier if to solve the surface of problem by giving people the instant treatment. The root of the problem is usually neglected, it is probably because of people's mentality of not to see the "real problem". Health disparities include a very complicate combination of problem through education, economy, politics, and today's moral trend. These complications are chain to each other and affect each other direct or indirectly. I strongly believe prevention is the key way to solve the root of health care problem and it is a much more efficient and cheaper. However, direct medical care service is easier to implement since it doesn't involve any complication. In order to fight this wrong mentality of "too lazy to fix the real problem", we, the public health people will need to fight the right for the budget for the prevention. In addition, I think education starts from kindergarten or early elementary school year will be one of the best methods to prevent many kind's diseases as the children grow older. It will take half or a full of generation to see the difference, but it is worth it!

When It Comes to Policymaking...

Spending on health services should be split equally between prevention and direct medical services or at the very least, there should be more money allocated for preventive services. What many don’t realize is that there are numerous underlying factors that determine illness/injury. Many believe that access to services is a necessary component of health care and is the reason for such poor health outcomes. Policymakers should really look into other factors that attribute to health disparities such as education, housing, income security, nutrition, and environment. A shift in the focus on health care services from restorative to preventive medicine would not only save patients and health care providers more money, but it would save millions of lives. The downside is that results are not immediate. Studies show there are 5 simple preventive services that would save more than 100,000 lives each year in the United States.

LOW USE OF PREVENTIVE CARE COSTS LIVES

Utilization rates remain low for preventive services that are very cost effective and have been recommended for years.
· Daily aspirin therapy to prevent heart disease.
· Smoking cessation: An additional 42,000 lives would be saved each year by increasing to 90% the portion of smokers who are advised by a health care professional to quit and are offered assistance. Currently, only 28% of smokers receive such services.
· Colorectal cancer screening: Another 14,000 additional lives would be saved each year by increasing to 90% the portion of adults aged 50 and older who currently receive any recommended screening for colorectal cancer. Today, fewer than 50% of adults receive these services.
· Flu vaccination: An additional 12,000 lives would be saved each year by increasing the portion of adults aged 50 and older who get an annual flu vaccination to 90%. Only 37% of adults currently get an annual flu vaccination.
· Breast cancer screening: An additional 3,700 lives would be saved each year by increasing to 90% the portion of women ages 40 and older who have been screened for breast cancer in the past 2 years. Today, 67% of women have been screened in the past 2 years.

Health: Our Social Responsibility

Prevention of disease is an extremely complex and fundamentally challenging topic to broach, particularly in the United States.  In todays world, we continually search for instantaneous solutions to complex issues.  When sickness strikes, we look to doctors and pills as magic bullets for disease burden. When it comes to disease, we all want to believe that we're immune from any obtaining any sort of illness or horrific disease until we are in fact stricken. 

Despite this belief and regardless of genetics, diet, or otherwise no one is above illness.   This is why in order for the country to begin a transition period into a more socialized approach to health, we as citizens MUST take out a greater personal stake in our own health.   Health is something that must be continually strived for a daily basis. Expecting the government to implement a blanket health system and provide more preventive health measures is ludicrous considering we continue to maintain a lack of accountability in our own health (i.e. cigarette smoking, poor dietary patterns etc.). 

It is entirely ridiculous to say that the government should provide more preventive measures when we, ourselves, fail to take responsibility for our health.  Until a fundamental shift occurs in which we fully believe in the supreme autonomy and accountability of the human being, no "magic bullets" should be expected, nor deserved.  

When It Comes to Policymaking...

There is no question that direct medical services provided by hospitals and physicians are vital for the health care system- let's face it without it people would die. But I think a lot can be learned from professor Gostin's quote. The the U.S. Health Care System puts a tremendous strain on direct medical services. There does not really seem to be a fair "sharing of common burdens". Rather it seems that a disproportionate amount of power is given to direct medical services (95% direct medical services to 5% prevention). This certainly is not the best approach. I think for a long time, medicine has encompassed the process of providing medical services to those in need. Effectively, this system has given rise to on the spot treatment services for those who have no other choice. Moreover, our nation's hospitals and clinics are filled with people who have lived unhealthy lifestyles for all their lives and have been aloof to health education altogether. There certainly needs to be a massive addition of health education into society. But it is not enough to simply educate the public about pap smears and immunization- they must be mobilized to take action and encouraged along the way.

I think its really important to understand that preventative medicine does not simply mean immunizations and pap smears; eating healthy, making more conscientious decisions about one's body, and exercising are all excellent ways to effectively prevent the onset of future health issues. Even instilling health promotion campaigns which incorporate these rudimentary elements would go a long way in preventing numerous illnesses.