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Steven Yates

Health-care reform should focus on primary prevention 

by Steven Yates     Steven Yates holds a doctorate in philosophy from the University of Georgia and a master’s of public health in health education from the University of South Carolina. He also teaches philosophy at the University of South Carolina Upstate in Spartanburg.

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.

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