In the May 28 issue of JAMA, Steven Woolf provides a particularly insightful commentary on the case for allocating more resources to primary prevention.
The commentary does not feature an abstract, but Wooff clearly "gets it," and addresses a number of crucial points we've mentioned here on MH Blog, including:
- the improvements in health and the reduction in human suffering (what Wolff terms the "compress[ion] of morbidity") that prevention and public health promises (based on excellent evidence);
- the "paradox" that we invest approximately 1-3% of health care expenditures;
- prevention and public health feature a lower cost-effectiveness ratio than other forms of health care (such as treatment), and are therefore preferable even if prevention does not "save money" due to the prevention paradox;
- that the attention given to negative results obtained for some prevention activities both downplays the abundant evidence for numerous prevention activities that do work and ignores the "absence of an infrastructure for implementation;"
- and notes that the issue is not one of absolute dollars, but of relative priority (i.e., how we allocate the dollars we are already spending):
"Resources for health promotion and disease prevention exist in the bloated U.S. health care budget ($2 trillion per year), much of it consumed by overuse and overcharging. Services with no measurable health benefit consume 30% of Medicare dollars."[citation omitted]
Indeed! Point. Click. Read.
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