Health Promotion and Preventions
Health promotion and disease prevention are processes that enable individuals to improve their health.
Health promotion seeks to increase an individual’s control over their health by addressing behavior under the control of the individual. Disease prevention is associated with medical and public health activities to prevent diseases. Health promotion and disease prevention have been utilized in the U. S. health care system for many of years and extensive research has been done on which preventive measures are most likely to protect individual health.Studies have also been done on what degree can preventions contribute to controlling costs of health care. Research supports the effectiveness of the preventative measures such as immunization, some forms of screening, avoidance of a high-fat diet, regular moderate exercise, as well the avoidance or cessation of exposure to tobacco.
But research has also shown that preventative measures increase, rather than reduce, health care costs. Research has shown that preventative interventions preserve function and extend lives.Studies have shown immunization to be a good example of a prevention that promotes individual health and longevity. The benefits of immunization can been seen in young people and in the elderly. For decades the elderly have been receiving vaccination against influenza and it is also commonplace for young children to receive inoculations for diptheria, tentanus, pertussis, polio, meningitis-causing Haemophilus influenzae, measles, mups, rubells, and hepatitis B. 1 A study from the Netherlands demonstrates the health benefits of the elderly receiving annual influenza vaccination.The findings from the study were that the those who received annual vaccination experienced a reduced mortality risk of 24 percent and it was estimated that the vaccination prevented one death for every 302 people vaccinated.
1 Immunization has also eradicated diseases that once threaten the lives of children in the U. S. , as illustrated by the history of the disease pertussis. Between 1934 and 1943 there were on average 200,000 annual incidence of the disease, including over 4,000 deaths. After the introduction of childhood vaccination for pertussis in the 1940’s, reported cases drastically declined and reached a low of 1,000 in 1976. Research has also shown that some types of screening are good examples of preventative measures that effectively protect individuals. Screening is a strategy used to detect a disease in individuals who are without signs or symptoms of that disease.
Between the early 1970s and 2000, use of the Pap test decreased incidence and mortality from invasive cervical cancer by 40 percent in the U. S. 1 The screening is almost an ideal because it is inexpensive, convenient, effective in detection, and cervical cancer is highly curable when detected early.The U. S. Preventive Services Task Force also strongly recommends screenings for colorectal cancer, high blood pressure, and Chlamydia infection. 1 As significant as disease prevention, health promotions in lifestyle and risk reduction in the areas of tobacco, body weight, diet and exercise have been shown in studies to protect individual health.
The most important of these studies that show the benefit of lifestyle preventative practices are the Framingham Heart Study and the Nurses’ Health Study.The Framingham Heart Study has been a main source of information regarding an individual’s attributes that lead to cardiovascular disease. The early findings of the study identified smoking, high blood pressure, cholesterol and glucose intolerance as risk factors for heart disease. 1 Before the study it was thought that heart disease may be unpredictable. Recently findings show that low-density lipoprotein cholesterol is a characteristic predictive of heart disease. The Framingham study had major implications on lifestyle in regards to physical activity and diet as preventative practices.It showed the low-density lipoprotein cholesterol was less common in physically active individuals.
The study also showed that being overweight is associated with risk factors such as lower levels of high-density lipoprotein, high blood pressure, and diabetes. The Nurses’ Health Study found similar results regarding the effects of diet and lifestyle on heart disease. The study concluded that among women, adherence to preventative practices involving diet, exercise, and abstinence from smoking is associated with a very low risk of coronary heart disease. The health risks of certain diets have also been the subject of many studies. Trials have shown that consumption of trans fatty acids produces factors that are predictive of heart disease. 1 Alternatively, studies have concluded that a preventative practice of a diet rich in non-trans fats, whole-grains, abundant fruits and vegetable, and adequate in omega-3 fatty acids offered significant reduction in heart diease. 1 Health promotion and disease prevention has also been thought as a means to control health care costs in the US.
It is seems logical to assume that health care cost would be reduced by individuals avoiding illness and that illness detected early are less expensive to treat. Research has shown that some preventative measures may reduce health cost, but many actually increase health care cost. The work of the economist Louise B. Russell offers very informative cost effectiveness analysis of the preventative practices of vaccination. 1 Russell studied a campaign during the 1960s to inoculate children against the measles shortly following the introduction of an anti-measles vaccine.She calculated the cost of the immunization intervention to be the sum of the cost of administering the vaccines and the cost of treating people who contracted measles, which included children that may have missed the vaccine or for who the vaccine was ineffective. Russell’s findings were that the intervention saved 973 lives and prevented 3,000 children from being mentally retarded.
She also found that campaign reduced absenteeism from school and work due to measles by 34 million days.She concluded that the intervention cost $31 million, but saved $200 million in institutional care for children who would have become retarded had they not been vaccinated. This type of preventative measure can be seen as very cost effective. Russell also concluded that other vaccination programs weren’t cost effective. She found that a small pox vaccination administered to 37,901 people because of a threat of bioterrorism attack resulted in 85 hospitalizations, 10 life-threatening diseases, 2 permanently disabilities, and 3 deaths. This intervention proved very costly since there wasn’t a bioterrorism attack.The preventative measure of screening also proves to increase cost of health care in the US.
The costs of screening include the diagnosis, medication, doctor visits, and treatment of side effects. Additional cost also result from the increased life expectancy of the individuals who are successfully treated. Conversely, if an individual isn’t screened the individual’s death result in the end of incurring health care costs. Screening for colorectal cancer, the third leading cause of cancer-related mortality in the U. S. , also revel an increase in the cost of health care.The American Cancer Society recommends that colonoscopies be the preferred method of screening.
In 2005 colonoscopies amounted to 60% of all colorectal cancer tests. 3 But colonoscopy is expensive and carries a higher risk of serious complications that other screening choices. Cost benefit analysis of cervical cancer screening also illustrate the increase in health care costs. Studies by a research team in Georgetown University indicated that Pap tests reduced deaths by 75% when done every three years and the cost per quality-adjusted life year gained would have been $11,839.The study also found that a more aggressive treatment resulted in deaths reduced by 95%, but the of a cost per quality-adjusted life year gained would increase to $76,183. 1 Health promotion interventions in lifestyle offer uncertain cost-effectiveness and cost impact. A case can also be made that tobacco control increases the costs of health care and that smoking itself is an effective cost control.
Smokers due require more medical care when they are alive, but upon the death of smokers, saving can be realized in nursing homes expenses, and the unutilized pension and Social Security benefits.Cost effectiveness analysis is not a complete approach to view health promotion and disease prevention. Though costly, preventative interventions in immunization, screening and lifestyle have been found by research to protect individual health. Cost effectiveness analysis should then rather be concerned with comparing alternative interventions. A good example of this type analysis is of colorectal screening, in which recommendation was for the intervention that would save the most lives at a given expenditure level. Russell said it best that “even when prevention does not save money, it can be a worthwhile investment in better health, and this- not cost savings- is the criterion on which it should be judged. ”1 1.
Greenwald HP. 2010. Health Care in the United States: Organization, Management, and Policy 2. Stampfer MJ, Hu FB, Manson et al. 2000. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med 3.
Subramanian S, Bobashev G, Morris RJ. 2010. When budgets are tight, there are better options than colonoscopy for colorectal cancer screening. Health Affairs