The future
of health care in America has become a major national
conversation, and rightly so. Should we embrace President Barack
Obama’s proposed overhaul of the entire health-care system,
or are
there too many potential legislative land mines buried in the
1,000-plus page bill before Congress (HR 3200)?
I
propose that our conversation should include more about primary
prevention.
Health
educators speak of “three levels of prevention.”
This is really a
misnomer: they mean, “three levels of care,”
prevention applying only
to the first. Be that as it may:
Primary
prevention is the full range of activities you do to avoid getting sick
or someday becoming infirm. It includes eating a proper diet and
exercising; not smoking; and not engaging in risky behavior. For women,
routine mammograms are part of primary prevention, as are DREs for men.
Primary prevention obviously involves education. It is not about what
has happened but what might happen, and how to take precautions.
In
the language of systems theory, primary prevention aims to strengthen
body systems, making them less vulnerable to attack by disease agents
or other sources of disruption and potential dysfunction. This includes
acquiring the necessary information and then acting on it.
Secondary
treatment is what you do after you’ve gotten sick —
it can range from
taking aspirin and sleeping for a few days to visiting your doctor and
filling prescriptions. A disease agent (e.g., a virus or bacterium) got
past your body’s defenses. The purpose of secondary treatment
is to
restore your body system’s previous equilibrium.
Tertiary
care, finally, is what must be done if disruption is so extensive that
restoring previous equilibrium is impossible. Probably the best example
is a disabling stroke, leaving a person partially paralyzed or unable
to speak. Tertiary care includes not just physical and occupational
therapy for the patient but also education and counseling for the
family, since tertiary care situations disrupt the larger family system.
The
problem is that most health care in America focuses on the second
and third of these, while largely neglecting the first. If we are to
get the health-care crisis in America under control, this must change.
Everyone
knows about the worrisome levels of obesity including in
children. People are obese because they eat too much junk, obviously.
As lack of proper nutrition weakens their body systems over time, this
invites long term health problems. While of course some people are more
genetically vulnerable than others, many disease conditions can be
linked to the near-absence of primary prevention: diabetes, heart
disease, many cancers, breathing disorders, chronic fatigue,
osteoporosis, and possibly even Alzheimer’s disease which has
been seen
in younger and younger ages.
Unfortunately,
primary prevention is unlikely to gain the support of much of the
health-care industry. The reason is not hard to see. Health care in
America is profit-driven. Doctors, hospitals, other health care
providers — not to mention insurance companies and the
multibillion-dollar pharmaceutical industry (Big Pharma) —
like to make
money. Even “Obama-care” is money-focused, aimed at
“cost containment.”
Because
of this focus, there is a sense in which we do not really have a
health-care system in America. We have a sick-care system —
amidst one
of the unhealthiest populations ever, relative to our level of
knowledge and technical know-how. And as much talk as we hear about
change, we don’t have much motivation from the
“establishment” (which
includes federal and state agencies) for change.
Much
of the burden necessarily falls on the educational system to
incorporate a strong primary prevention component into core curricula.
Adults, meanwhile, must take matters into their own hands as much as
possible; adult-education classes focused on primary prevention are
certainly desirable!
Given
an aging population, this must be done! Otherwise, in a few short
years, the costs of caring for increasingly large cohorts of aging and
sometimes disabled baby boomers will leave us with a spectacularly
nasty choice: between de facto euthanasia (triaging elderly people and
not dispensing life-prolonging treatments) and the insolvency of the
health-care system! This will be the case regardless of whether we
embrace Obama’s ideas or someone else’s!
If
this sounds apocalyptic, just do the math. I am not suggesting yet
another set of laws. Genuine, lasting change must build from the bottom
up, not from the top down.
Communities
that embrace primary prevention as a way of life will spend fewer
dollars on doctor visits, hospital stays, and pills; lack of affordable
health insurance is a problem that will begin to solve itself. People
will look better, feel better, work better, and live longer! Our entire
perception of medicine might change. If this poses a threat to the
medical “establishment” (and Big Pharma), then so
be it.
Steven Yates earned his
Ph.D. in philosophy in 1987. He is the author of the book, Civil
Wrongs: What Went Wrong With Affirmative Action
(San Francisco: ICS Press, 1994) and numerous articles both in academic
journals and elsewhere. He has taught philosophy at Clemson University,
Auburn University, Wofford College, the University of South Carolina,
Southern Wesleyan University--Columbia, and Midlands Technical College,
and has held fellowships with or worked on projects with the Institute
for Humane Studies, the Heritage Foundation, the Heartland Institute,
and the Acton Institute for Religion and Liberty.
