Single-Digit Prevention

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Volume 14, Number 9

Although 75% of healthcare expenditures in the United States are related to chronic disease management, only 3% is spent on the prevention of these chronic illnesses. Perhaps it shouldn’t be surprising that only 8% of US adults aged 35 and older get all of the recommended preventive services that are indicated for them, according to an analysis recently published in Health Affairs.  Such preventive services include: screening for elevated levels of blood pressure and cholesterol, for breast and colon cancer, and for osteoporosis; screening and counseling regarding tobacco use, alcohol use, weight management, and depression; and receiving indicated vaccinations.

Upon closer examination, only one-fifth of adults get at least 75% of recommended preventive services, while 16% receive less than one-quarter of the services recommended for them. There are many reasons why only a single-digit percentage of adults receive all of the services recommended for them. There can be variability in specific recommendations published by different health organizations. In spite of available scientific data, personal beliefs can override the recommendations of health professionals (e.g., refusal to receive immunizations). Many individuals live with an illusion of invulnerability and report they will do something about a health problem if and when it occurs, even though the goal of prevention is to keep the problem from occurring in the first place. In some cases, socioeconomic factors affect access to preventive services or present barriers to the implementation of lifestyle recommendations.

With respect to physical activity recommendations, data recently reported by the Centers for Disease Control and Prevention (CDC) from the 2010-1015 National Health Interview Survey indicated that only 22.9% of US adults (ages 18-64) met 2008 federal guidelines. These guidelines recommend at least 150 minutes per week of moderate physical activity (or 75 minutes per week of vigorous physical activity), and muscle-strengthening activities at least two times per week. (The percentage for Ohio was 23.9%, slightly better than the national average.)

“An ounce of prevention is worth a pound of cure” is a quote attributed to Benjamin Franklin, and at its utterance was referring to fire safety in the city of Philadelphia. The quote is often now used with respect to health. While studies of the cost-effectiveness of preventive services may not see the 1:16 yield implied by Franklin’s quote, every dollar spent for many preventive services is associated with a subsequent five-dollar savings in healthcare costs.

One of the keys to controlling burgeoning healthcare costs is a greater investment in and commitment to health promotion and disease prevention. Importantly, this starts at the individual level with taking greater responsibility for one’s health rather than abdicating that responsibility to physicians or other health professionals. An individual can inquire about being eligible for recommended preventive services, rather than passively waiting for a recommendation. Physical activity levels and dietary quality are the responsibility of the individual. A person can cast a vote that impacts health-related policy. The health and economic benefits of prevention make it imperative that commitment to prevention moves well beyond the single digits in investment and implementation.


Paul J. Hershberger, Ph.D.

… is a clinical health psychologist. He is Professor, Director of Research, and Director of the Division of Behavioral Health, Department of Family Medicine, Wright State University Boonshoft School of Medicine.




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