Wednesday, July 8, 2009

Prevention is the real cure

I came upon an interesting news item last week, on a day when I'd been thinking about the 'diabesity' epidemic rolling across North America and the absence of any new public health initiatives targetting this reversible 'lifestyle' disease.

"Spending on heart drugs growing fast" was the headline. A new study revealed that spending on cardiovascular drugs to prevent and treat heart attacks and strokes had jumped 200% between 1996 and 2006! Statins, a class of drug routinely prescribed to lower cholesterol, now account for 40% of the over $5-billion spent yearly on heart medications.

Prescription drug spending, by the way, is the fastest rising component of our public healthcare spending, and has been for a long time. Healthcare spending is increasingly an issue in politics, especially for parties of the right like the B.C. Liberals, who tell us we can't afford to fund the system we have today into the future.

The principal causes of high cholesterol are the same culprits behind the shocking rise in type two diabetes, which snares over 20,000 BCers every year: poor diet and physical inactivity. We just eat way too much junk food, sugar and salt, and sit too long on our butts distracted by electronics rather than moving about.

Our public policy response to date is typical - we 'medicalize' the syndrome resulting from poor lifestyle choices and absorb the impact via rising healthcare costs. But we don't intervene to increase activity levels and improve dietary choices, which would effectively reduce the amount of illness showing up and over time decrease sickness spending.

Doctors are trained to issue drug prescriptions for the syndromes that precede illness, like high cholesterol. In a well-intentioned way they're trying to prevent incidents, like strokes, that cripple people for life. But these drugs enable the poor lifestyle choices to continue and healthcare walks blindly past prevention, its natural power tool. And doctors rarely prescribe more exercise and better diet.

Meanwhile, politicians of all stripes prattle on about soaring costs - whether from the perspective that we cannot afford to keep paying, or from the perspective we must find the way to keep paying. Either way, no one proposes effective interventions that would change lives and reduce the incidence of disease.

This is a curious conundrum. Take Type Two Diabetes for example - over 220,000 in BC live with TTD and its complications; more than 20,000 are added annually, and costs rise by about $75-million a year for this preventable lifestyle disease alone. Obviously this isn't sustainable, certainly not in times when revenues to the Crown evaporate due to economic recession.

We value our public healthcare system because it's there when we need it, without regard for our ability to personally pay. That's important, because sooner or later 'events' require interventions in a life to preserve and extend it.

But our healthcare providers are focussed on sickness cure, stabilizing individual lives by heroic interventions. They rarely if ever formulate plans to intervene to prevent illness from ever happening.

And yet, almost all the advances in the life expectancy of individuals have come from well-designed public health initiatives - from clean drinking water to smoking cessation. Drugs and heroic interventions still save those not protected by preventive measures, but the big gains come from prevention.

We're seeing massive growth of lifestyle diseases due to identifiable factors: eg, industrial fast foods and sedentary living. These are reversible if society, via politics, takes steps to reshape the environmental conditions that cause them.

Americans today consume on average 300 calories per day more than they did 20 years ago. If eating one additional jellybean per day adds a pound a year (or ten in a decade!), think what 300 calories a day do to manufacture obesity and predispose inactivity!

The goal should be to return the vast majority of us to a daily balance, where calories 'in' equate to energy 'out', rather than posting a continuing surplus. How we do that means looking to underlying conditions, like how our communities and the roads linking our neighbourhoods to work, school and services are designed. Or looking at the way industrial foods are formulated, using too much sugar, salt, fats and carbs, and taking steps to reduce these ingredients.

Interventions at this scale - to make daily walking, for example, more convenient and attractive, or daily diet more nutritious and less toxic - will over time reduce the incidence of 'metabolic syndrome', which precedes lifestyle diseases.

It's absolutely true that we need a pool of money to physically rejig our living spaces to predispose more exercise - but a lot of that money is already collected and misspent on the wrong priorities. Think of all the fuel taxes collected at the pump for vehicle travel - why isn't some of that earmarked for the physical redesign of our cities? What about the feds grabbing ten cents a litre plus GST - why shouldn't that be used to improve community design, promote active transport, and reduce healthcare costs over time?

Many such public health initiatives will pay for themselves over time, because they prevent illness and debility we'd otherwise pay for under health and other social programs. They also keep people working and families whole.

My blood boils when I read about escalating healthcare costs and then hear politicians rabbiting on about whether we can or can't afford to pay. How about focussing on interventions that reduce the incidence of illness - try that tack for a while instead of indulging your political ADD.

Say, if you don't have any ideas of your own, just give me a call. I and a couple of friends can generate a half dozen effective interventions pronto. Go ahead, call my bluff!

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