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Prevention is also about changing provider behavior and the structure of reimbursement (e.g., diabetes care). That in itself can have a big impact.

We respectfully disagree! Prevention is a huge part of the answer. From our company’s first-hand experience, PinnacleCare is getting an influx of people motivated to prevent medical issues, especially when they learn of documented proof that eliminating certain foods is important for cardiac health or changing a small habit can help in the prevention of certain cancers. Yes, people who are motivated in general are also the first to change behaviors. And, PInnacleCare does see that. But, we also see less assertive people making incremental changes, getting support from us, and making more changes. They feel better and that verifies the science. They are convinced that their prevention moves will improve their quality of life, now and later. And so are we!

The bypass operation example is discouraging and that’s why the best hospitals insist that candidates get counseling ahead of time to understand full commitment beyond surgery. That’s when we see a continuance of improvement. The best specialists will not proceed without a full circle approach to maintaining weight loss. When counseling and support are not in place, old habits return.

Call me an optimist, but I think with the right approach/incentives/framework, most people can get very motivated to change. Somehow, smart companies will learn how to tailor their messaging & product design accordingly that maximizes impact.

Prevention can produce better health and even if a modest investment in prevention ended up saving say 10% of health care cost the numbers over time are hugh. Prevention must not be seen as a tool but as the tool box. The challenge is to bring all the tools together (economic, behavioral, social, political, technology, bio-medical and public health sciences, and management) to the tool box of prevention. This presents a significant obstacle to making prevention real but work needs to be done in this arena. If not, prevention will remain a good theory but only that. Joint Public and Private endeavors that connect health care directly to all the other tools need to be explored and put into practice within defined populations.

Last spring, I sat in a dinner with numerous national public leaders and the discussion revolved around planning for 2009. What fascinated me was that the conversation turned immediately to access to care. This from leaders in public health. For me this pointed to what I believe is a fundamental problem of advancing prevention which is that few leaders truly understand the transdisiplinary nature of prevention or how to create the vision and make the case for prevention as an essential driver of health reform - not health care reform.

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