Why preventive care is such a tough sell in the US, according to chronic disease experts

WASHINGTON With the prevalence of some chronic diseases rising, the United States needs to revamp its approaches to preventive care and disease management, experts said at the Milken Health Futures Summit on Tuesday.

Already 6 out of 10 Americans living with a chronic condition, and 4 out of 10 live with at least two. Factors such as an aging U.S. population, delayed care during Covid-19 and the rising prevalence of obesity are only exacerbating the problem, said Karen Hacker, director of the Centers for Disease Control and Prevention’s National Center for Chronic Disease Prevention and Promotion. diseases. .

We have amazing innovation in this country, we have amazing pharmaceuticals in this country, but we have literally, shall we say, disinvested in prevention, Hacker said.

Anand Parekh, chief medical adviser for the Bipartisan Policy Center, pointed to the lack of primary care physicians and the health care fee-for-service model as major obstacles to the future of chronic disease prevention and management.

Fifty years ago in this country half of the doctors were primary care doctors, half were specialists, he said. We were now at a point in this country where only about 20 to 25% are actually in primary care. I think we need to look at workforce issues, payment and reimbursement issues, to really elevate the primary care workforce.

However, preemptive action can be a tough sell for policymakers. Improved health outcomes take time and require good data tracking, Parekh said.

Prevention efforts take time to reap benefits when it comes to health outcomes, and policymakers need to be patient, Parekh said. He added that positive outcomes with preventive care are often difficult to demonstrate or demonstrate because something has not happened.

One of the biggest challenges for public health efforts is dispersed patient data. Diagnoses of a chronic condition, such as diabetes, are not tracked and reported in the same way as infectious disease outbreaks, a problem that Hacker and the CDC hope to one day solve.

Data is everywhere. It is in every health system, in every insurance system. People are constantly moving between them, so it’s hard to really identify who’s who. That’s certainly one of our challenges, and right now we’ve been involved in trying to look at a comprehensive approach to tracking chronic disease for the nation, Hacker said.

In the middle rise in Alzheimer’s disease due to the aging of the US population, public health officials are also pushing for more integrated approaches to prevention. Although risk factors for cardiovascular disease, diabetes, and hypertension may increase the likelihood of developing Alzheimer’s disease and dementia, approaches to chronic disease prevention have traditionally been simulated.

When we look at these risk factors, they are indeed transferable, said Kristen Clifford, chief program officer at the Alzheimer’s Association. One thing you’ll hear me say is, what’s good for your heart is good for your brain. But how do we send that to the public, how do our healthcare providers send that?

According to Hacker, better prevention of chronic diseases also depends on non-medical interventions. Social determinants of health that include access to food, housing, transportation, and other factors play a major role in people’s health outcomes. The public health sector requires more upstream strategies to reduce these disparities.

As I have seen these types of strategies unfold and the health care system become more engaged in social determinants, I hope that we in public health can amplify those messages, Hacker said. That we can essentially wrap around what’s happening in the clinical delivery system with the individual really thinking about populations.

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