Power of prevention: 100,000 lives could be saved a year

The Partnership for Prevention says more than 100,000 lives could be saved every year in the United States if use of five preventive services were increased. The total includes 45,000 lives the group says would be saved each year if more adults took a daily low-dose aspirin to prevent heart disease. The study was funded by the Centers for Disease Control and Prevention, the Robert Wood Johnson Foundation, and the WellPoint Foundation.

The study found that better use of measures such as more adults getting flu shots and being screened for cancer could save tens of thousands of lives each year. It documented serious deficiencies in use of preventive care for the nation as a whole, and particularly troubling problems among racial and ethnic populations.

"A lot of Americans are not getting life-saving preventive services, particularly racial and ethnic minorities," said National Commission on Prevention Priorities chair Eduardo Sanchez. "As a result, too many people are dying prematurely or living with diseases that could have been prevented. We could get much better value for our health care dollar by focusing upstream on prevention."

Indeed, the power of prevention could yield a considerable impact, as the study projected:

  • 45,000 additional lives would be saved each year by increasing to 90% the portion of adults who take aspirin daily to prevent heart disease. Today, fewer than half of Americans take aspirin preventively.
  • 42,000 additional lives would be saved each year by increasing to 90% the portion of smokers who are advised by a health professional to quit and are offered medication or other assistance. Today, 28% of smokers receive such services.
  • 14,000 additional lives would be saved each year by increasing to 90% the portion of adults ages 50 and older who are up to date with any recommended screening for colorectal cancer. Today, less than 50% of adults are up to date with screening.
  • 12,000 additional lives would be saved each year by increasing to 90% the portion of adults age 50 and older immunized against influenza annually. Today, 37% of adults have had an annual flu vaccination.
  • Nearly 4,000 additional lives would be saved each year by increasing to 90% the portion of women age 40 and older who have been screened for breast cancer in the past two years. Today, 67% of women have been screened in the past two years.
  • 30,000 cases of pelvic inflammatory disease would be prevented annually by increasing to 90% the portion of sexually active young women who have been screened in the past year for chlamydial infection. Today, 40% of young women are screened annually.

Minorities use less preventive care

According to the report, African Americans, Hispanic Americans, and Asian Americans all use preventive services at lower rates than the white, non-Hispanic population in the United States.

"This report documents that minority groups in America use less preventive care," said former U.S. Surgeon General David Satcher. "One reason is that many Americans, particularly minorities, have no continuity in their healthcare, no relationship with a doctor or other medical professional who can ensure that they are getting the preventive care they need. We have to transform our sick care system into a health care system that works for everybody."

One question that arises out of the report is why people don't receive the preventive services they need. The report says the reasons are complex, but offers these contributing factors:

1. Many health care providers lack systems or fail to use systems to 1) track their patients to determine who needs preventive services; 2) contact those patients to remind them to get the services; 3) remind themselves to deliver preventive services when they see their patients; 4) ensure the services are delivered correctly and that appropriate referrals and follow-up occur; and 5) make certain the patients understand what they need to do.

2. The U.S. health care system benefits specialty care and acute care treatment at the expense of primary care and prevention, as evidenced by limited investment in developing a prevention-oriented health care work force and limited training for doctors and other health care providers in delivering preventive care. For example, there is too little emphasis on delivering effective brief counseling messages to change behavior and improve compliance with prescribed medications that prevent disease and death.

3. Demand for preventive services among consumers is weakened by high out-of-pocket costs for preventive services faced by the uninsured and those who have high-deductible insurance plans without exceptions for preventive care. Some 46 million Americans have no health insurance coverage. Two-thirds of the uninsured are either poor or near poor, and minorities are more likely to be uninsured than white Americans.

4. Many Americans, particularly minorities, have no connection to a regular source of health care with providers that will help ensure they are getting all the preventive services they need. In a 2006 survey, only 27% of Americans ages 18-64 reported having a regular doctor or source of health care and a medical home. Three-fourths of white, African Americans, and Hispanics with medical homes reported getting the health care they need when they need it, compared to 38% of adults without any regular source of health care.

5. People often are unaware of the preventive services that are recommended for individuals of their age, gender, and risk factors, do not consider themselves to be at risk, or are uncertain about the effectiveness of certain preventive services. Behavior change also is very challenging. Many people have great difficulty increasing and maintaining their exercise levels, changing and maintaining their diets, and permanently quitting smoking. Some preventive services, such as colorectal cancer screening, can be difficult to prepare for and are time-consuming.

Download the report at www.prevent.org.