THE PREVENTIVE CARE PARADIGM SHIFT
HEALTHCARE PROFESSIONALS HAVE known for a long time that preventive healthcare is vital for their patients’ health and well-being.
Perhaps what has been lacking is a blueprint for healthcare professionals to collaborate with each other and with their patients; a guide to help them achieve quality preventive healthcare for the well-being of patients. Preventive healthcare is not a service that a physician can provide to a patient in the same way that treatment is provided. It requires more touches, a different mind-set, and a different set of tools than the treatment model. In addition to being dependent on genetic, environmental, social and economic factors, it requires an ongoing collaboration that actively involves policy makers, healthcare providers and patients.
Our aim in engaging in this conversation is to nudge us collectively closer to partnerships where healthcare professionals empower and collaborate with patients to prevent disease or to detect and manage it in a timely manner, hence improving Quality of Life.
A Pressing Need
The urgency for implementing proper preventive healthcare cannot be overstated. The current condition of our population’s health is alarming, and so are the collective healthcare outcomes.
Statistics indicate that most of the leading causes of death in the United States are chronic diseases that are largely preventable[i]. Heart disease, the leading cause of death, is responsible for 1 in 4 deaths[ii]; lifestyle behaviors are a major contributor to heart disease. In 2018, more than 1.7 million new cases of cancer will be diagnosed in the United States and more than 600,000 people will die from the disease, according to the National Cancer Institute.[iii] Cancer prevention and early detection could alleviate much of this suffering and death. Every 40 seconds, someone in the United States has a stroke, the Centers for Disease Control and Prevention (CDC) reports.[iv] Stroke is the leading cause of serious long-term disability in the United States. High blood pressure, high cholesterol, or being overweight increase the chances of having a stroke.
The CDC indicates that of the 30.3 million people in the United States who have diabetes, 23.1 million have been diagnosed, while a further 7.1 million people who have diabetes remain undiagnosed. Diabetes, besides being the 7th leading cause of death in the United States, can cause disabilities. It is the leading cause of kidney failure, lower-limb amputations other than those caused by injury, and new cases of blindness among adults. The risk factors for type 2 diabetes are largely lifestyle related—smoking, overweight and obesity, physical inactivity, and high cholesterol.[v]
Preventive care can be an effective tool in reducing the number of patients getting diabetes, and in slowing down or, in some cases, stopping disease progression. This would improve population health, improve health outcomes, and reduce healthcare spending. According to a recent study on the economic cost of diabetes, the US spent $327 billion on diabetes in 2017—which was 26% more than the $245 billion spent in 2012. Furthermore, the study found that 1 out of 7 healthcare dollars is spent on Diabetes.[vi]
The Importance of Patient Engagement
We have known for a long time that lifestyle choices have a tremendous effect on health and wellness. For instance, the Danish Twin Study came to the conclusion that about 80 percent of how long we live is due to how we live, including our lifestyle, habits and culture. The remaining 20 percent is based on our genetics or access to basic healthcare.[vii]
The shift from disease and poor quality of life to Optimal Wellness is possible. But Patient engagement is crucial for preventive healthcare to succeed.
Primary Care Providers see many types of patients; from the highly engaged and proactive patients who will do what it takes to make changes to their lifestyles that will improve their quality of life, to the very disengaged and reactive patients who do not want to be part of the solution, and just want someone (usually their physician) to “fix” them.
A well-balanced health and wellness program that includes preventive care can encourage patients to move towards the upper right quadrant, where they are proactive and empowered to be part of the planning and decision-making process in their healthcare.
A Worthwhile Endeavor
The effort is well worthwhile. Good health, high quality of life and lack of disease have been studied in the five longevity hotspots in the world called ‘blue zones’, which provide an excellent blueprint for engaged preventive care.[viii] People in the blue zones, (Ikaria, Greece; Okinawa, Japan; Ogliastra Region, Sardinia, Italy; Loma Linda, California; and Nicoya Peninsula, Costa Rica) live longer, have an average of 12 better quality years, and don’t suffer from diabetes, obesity and cancer. Their dietary and other lifestyle choices hold the answers to their outstanding health and longevity.
In Loma Linda, the only Blue Zone in the United States, the emphasis on diet and health, a hallmark of the Seventh Day Adventist culture that permeates the area, plays a big part in the health and wellness of the residents. The Seventh Day Adventists advocate for no drinking alcohol or smoking, no meat, no processed foods, and plenty of exercise. Fresh, local produce is easily available in the Loma Linda market. The proof is in the pudding. The Adventists in Loma Linda live an average of 10 more healthy years than other Americans.[ix]
Moderate activity throughout the day, eating a plant-based diet, living with purpose, reduced stress, engagement in family and social life, and practice of spirituality or religion were noted as features common to the blue zone areas.[x]
Dollars and sense
Besides promoting longevity and Quality of Life, preventive healthcare makes economic sense.
Treating chronic illnesses is substantially more costly than preventing them. Besides, there’s the cost of treating complications, the cost of in-patient care that often ensues, and the loss of productivity caused by long term sickness. For instance, it makes most sense to detect a tendency towards diabetes before it occurs, and to work with the patient to prevent it. One of every five U.S. health care dollars is spent on caring for people with diagnosed diabetes, yet in studies increasing physical activity to just 2½ hours a week and losing 5 to 7 percent of weight has reduced patients’ risk of developing type 2 diabetes by 58 percent.[xi]
Additionally, preventive care in the form of early detection using screening tests provides significantly better treatment outcomes sooner, and therefore lower cost of treatment. Immunizations prevent debilitating conditions that would cause much pain and suffering, and do so at a low cost.
Preventive healthcare incorporates early planning for care; providing an opportunity to tackle illnesses using the right tools and the right therapies from the get-go. For instance, pharmacogenomic testing, which is a key part of precision medicine helps identify the most appropriate therapy for individual patients sooner, cutting out the trial and error process of prescription.
[i] Centers for Disease Control and Prevention, National Center for Health Statistics, About Chronic Disease. www.cdc.gov/chronicdisease/about/index.htm
[ii] Centers for Disease Control and Prevention, Heart Disease Facts. www.cdc.gov/heartdisease/facts.htm
[iii] National Cancer Institute, Cancer Statistics. www.cancer.gov/about-cancer/understanding/statistics
[iv] Centers for Disease Control and Prevention, Stroke Fact Sheet. www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_stroke.htm
[v] National Diabetes Statistics Report, 2017. www.diabetes.org/assets/pdfs/basics/cdc-statistics-report-2017.pdf
[vi] “The Cost Of Diabetes”. American Diabetes Association, 2018, http://diabetes.org/advocacy/news-events/cost-of-diabetes.html. Accessed 13 Sept 2018.
[vii] Herskind, A. M., McGue, M., Holm, N. V., Sörensen, T. I., Harvald, B., & Vaupel, J. W. (1996). The
heritability of human longevity: a population-based study of 2872 Danish twin pairs born
1870–1900. Human genetics, 97(3), 319-323.
[viii] Buettner, D (2012). The Island Where People Forget to Die. New York Times. Retrieved at
[ix] Macvean, M. Why Loma Linda residents live longer than the rest of us: They treat the body like a temple. Retrieved at http://www.latimes.com/health/la-he-blue-zone-loma-linda-20150711-story.html
[x] “Eight Common Denominators To Live Longer”. News.Llu.Edu, 2018, https://news.llu.edu/research/eight-common-denominators-live-longer. Accessed 14 Sept 2018.
[xi] National Prevention Strategy, Economic Benefits of Preventing Disease. https://www.surgeongeneral.gov/priorities/prevention/strategy/appendix1.pdf