Where is Health?


This was not written as a blog entry. It was written as an op-ed piece for a newspaper. However, 4 major newspapers have rejected it, but I would like someone to read it, so I am sharing it with you. I wrote this piece because even before the health reform debate devolved into a depressing spectacle of shouting and fear-mongering, almost noone was talking about how reforms might actually improve health. Use your freedom of speech to make your views known on this critical national issue.

Where is Health?

Where is health in the debate over health care reform? The mass media debate is almost completely about improving health care coverage, reducing health care costs, and paying for the increased coverage. There is a great deal of media attention to the proposed public option for insurance, and we hear a lot from hospital groups, insurance companies, and the pharmaceutical industry about what the proposals would do to their businesses. But people’s health is virtually absent from the mass media debate; an afterthought at best. Every so often there is a passing mention of prevention or enhanced primary care, but no explanation of what that might mean.

Where is health in the Congressional debates? Believe it or not, health is present in discussions of preventing disease to both control health care costs and improve the health of Americans. Did you know that in the Senate three committees are working on health reform and one of those is focused on prevention and public health? I’m guessing you did not know that. I’ve been looking for reports on their work, and I don’t find them in the mass media.

Where is health on the minds of the American people? Surprise, it’s the number one priority for health reform. A May 2009 Trust for America’s Health poll of 1014 US voters identified prevention as the top priority of six health reform proposals that included universal health care coverage and prohibiting insurance companies from denying coverage based on pre-existing conditions. What’s more, 76% of voters supported investing more money in prevention, and that included at least 70% of Republicans, Democrats, and Independents.

Why is the public debate on health care so discrepant from the public’s interest in health improvement? This is a question that needs to be answered by media organizations, but here is my guess. The debate is being driven by money, health care industry money. Hospitals, insurance companies, pharmaceutical companies, medical device makers, medical testing companies, and physician groups are the beneficiaries of the current system that spends $2 trillion annually. They are on the receiving end of the unrelenting rise in health care costs. They have something to lose if Americans become healthier, so I imagine they are sending the most letters and emails to news organizations and lobbyists to Capitol Hill. Their primary concern is the financial health of their companies, so excuse them if they don’t talk much about the health of the American people.

Who is representing the voice of the American people who want a health system that helps them stay healthy and prevent disease? Almost nobody. There are public interest groups and foundations that are trying to make their voices heard and find some scraps for prevention, but they are no match for the lobbying activities of giant health care industries. If you are one of the 76% of American voters who wants health reform to create a health system that invests much more in prevention, you are going to have to speak for yourself. Express your opinion to your representatives and to news outlets.

But as we prepare to speak our minds, let’s be clear about what prevention really is. In the health care debate, prevention usually refers to mammograms, prostate screening, and cholesterol testing. These are worthy but not at the heart of making people healthier. Prevention can summed up by “3four50”. This means that 3 behaviors (smoking, inactivity, poor diet) contribute to four leading diseases (heart disease, cancers, diabetes, and lung disease) that in turn are responsible for 50% of all deaths in the world, more in the U.S. As everyone knows, achieving those behavior changes is difficult. But, if our health system was designed to focus on preventing smoking and helping people be physically active and eat sensible portions of nutritious foods, we could prevent disease, reduce the need for health care, and control health care costs. This is our chance for true health reform. Let’s add the voice of the American people to the debate before it’s too late.

Jim Sallis