‘Promise of prevention’: Q&A with Jeffrey Levi of Trust for America’s Health

April 25, 2012
by Kim Krisberg
Public Health Newswire

A little more than two years ago, President Barack Obama signed the historic Patient Protection and Affordable Care Act into law. The health reform law not only contained significant insurance reforms, but included landmark funding and directives to support a systemic and cultural shift toward a health care system that integrates evidence-based prevention. The law’s new investments in public health and prevention were met with praise and excitement from public health practitioners and advocates nationwide.

Those investments, however, are far from certain — as is the entire health reform law. Below, Public Health Newswire talks with APHA member Jeffrey Levi, PhD, executive director of Trust for America's Health, about his involvement in the new national push for prevention, the importance of sustained public health funding and how health reform is already making a difference. Trust for America's Health is a nonprofit organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

Q: On the Trust for America's Health website, it says “as a nation, we are stuck in a ‘disease du jour’ mentality” that prevents policy-makers and the public from taking a long-term view of health. What are the dangers of this mentality and how is your organization working to help change it?

With this type of mentality, the country can never have a true health care system. It boxes public health into reacting to the latest perceived crisis of the moment rather than focusing on doing what we know can improve the long-term health of Americans. Millions of Americans suffer from preventable diseases and conditions, which in turn cause needless suffering and drives health care costs.

Prevention is the key to halting the chronic disease epidemic, reversing obesity trends and curbing tobacco use. Obesity alone is related to more than 30 illnesses, including type 2 diabetes, heart disease and some forms of cancer. Adequately supporting prevention will lower health care costs and create a long-term path to a healthier and economically sound America.

Just looking at obesity: We at Trust for America's Health recently released a study that found if current trends continue, obesity rates could be expected to grow from 32 percent to 50-51 percent for men and from 35 percent to 45-52 percent for women by 2030. The study’s estimates predict these rates of obesity could contribute to more than 6 million cases of type 2 diabetes, 5 million cases of coronary heart disease and stroke, and more than 400,000 cases of cancer in the next two decades. The combined medical costs associated with treating preventable obesity-related diseases are estimated to increase by $48 billion to $66 billion per year in the United States by 2030 — while experiencing a loss in economic productivity as high as $540 billion. However, reducing average body mass index by just 5 percent could lead to more than $29 billion in health care savings in just five years due to reduced obesity-related costs. The analysis found that the country could save $158.1 billion in 10 years and $611.7 billion in 20 years.

Q: March marked the two-year anniversary of the historic health reform law, the Patient Protection and Affordable Care Act (ACA). What do you think have been the law’s biggest accomplishments to date? And what do you think will happen if the Supreme Court strikes down the law?

With the passage of the ACA, the country took the first step toward a true public health system, as the federal government finally committed to helping people take personal responsibility for their own health by making healthy choices easier choices. Included in the ACA, which eliminates co-pays for a wide range of proven, effective preventive services, is the Prevention and Public Health Fund, a historic investment over the next 10 years that goes to communities around the country to help them keep Americans healthier and more productive. One hallmark program of the prevention fund are the Community Transformation Grants, which provide communities with the resources needed to work together at the local level to create health initiatives tailored to their specific needs. This can involve small business owners, faith leaders, youth leaders, employers, community groups, parents, law enforcement officials, schools and health care providers. Regardless of what happens, there is strong momentum underway to improve prevention and think about how health is impacted by a range of factors beyond the doctor’s office.

Q: As chair of the federal Advisory Group on Prevention, Health Promotion, and Integrative and Public Health, how hopeful are you that prevention-related directives and funding included in the Affordable Care Act will result in real changes in the health of Americans?

The prevention fund continues to have a significant impact in improving health in the United States. The fund will provide more than $13 billion of new support for disease prevention over the next 10 years and $20 billion over the subsequent 10 years. By supporting evidence-based, locally decided programs around the country, we are on a path that will transform the nation’s sick care system into a real health care system. There are also a range of new preventive services that will now be available at no-cost to millions of additional Americans. Change will not take place over night, but if we continue to invest in prevention, we can ensure that the current and all future generations lead healthy, happy and productive lives.

More importantly, the ACA creates the National Prevention and Health Promotion Council (NPC), which brings together 17 federal cabinet agencies and offices from across the government to address prevention. This is setting the “health in all policies” table for the federal government and is reflected in the very broad approach taken in the National Prevention Strategy released by the NPC last year. The strategy commits the entire federal government, not just the health agencies, to integrating health into their work. That is a major culture shift that will bring more resources, programs and leadership to bear in the interest of creating a healthier nation.

Q: In February, Congress and the president agreed to shift $5 billion from the Affordable Care Act’s Prevention and Public Health Fund to offset cuts in Medicare reimbursement rates. Many public health advocates, including you, criticized the move. Do you think the February decision is a foreshadowing of what’s to come? And how can advocates help prevent future cuts to the prevention fund?

As noted above, the prevention fund is still having a significant impact in improving health in the United States. While this is a new investment in prevention, it is building on what we know are proven, effective ways we can improve health in America. In our recent “Investing in America’s Health” report, we included several profiles of prevention working in all types of communities all over the county in different ways. Public health and the public in general must work with policymakers to ensure these investments are maintained if we’re going to realize the promise of prevention.

Q: In March, Trust for America's Health released its annual “Investing in America’s Health” report, finding that most states have cut their public health budgets. Public health funding isn’t alone — states are making cuts across the board to make up for budget shortfalls. And some would say it’s only fair that public health absorb its fair share of cuts in light of our current economic problems. How would you respond to that?

These are certainly tough economic times and everyone has to do their part. However, public health funding has been cut significantly for some time now and, consequently, has been doing more than its part for years.

It is also shortsighted to cut public health and prevention funding, as it is one of the most common-sense and practical ways we can save health care costs in the country — by keeping people healthier in the first place. In addition, public health is as vital to personal and community well-being as any other emergency service. During a pandemic or natural disaster, public health is tasked with standing up many capabilities, including distributing medicines and medical countermeasures. We can’t just hire people who are not trained to do this during a catastrophe; we must continually invest and support public health departments or risk the consequences of being unprepared during a disaster.

Q: Trust for America's Health addresses a broad range of public health issues, from emergency preparedness to the country’s growing obesity epidemic. What would you say are the most pressing public health problems we face today — problems that we can’t afford to ignore?

As the new Institute of Medicine report, “For the Public’s Health: Investing in a Healthier Future,” outlined, there are fundamental things that every American deserves and should expect in terms of public health. We shouldn’t have to choose between preventing diseases or protecting people from emergencies. That said, we need to be as smart and strategic as possible in how we spend money, which may require some hard thinking. Implementation of the Medicaid expansion program will change how we think about some traditional public health roles, and we also need to think about cross-cutting health concerns, like focusing on nutrition and physical activity, in addition to thinking about disease-by-disease approaches to health.

To learn more about the work of Trust for America's Health, visit http://www.tfah.org/.

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