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Fixin' Healthcare

Friday, April 14, 2006

The Lifestyle Chronicles - You Can If You Try

Health promotion, healthy lifestyles and disease prevention are frequently discussed and often written about in the medical literature, as well as the press. Be that as it may, the practice of preventive health care has yet to gain widespread acceptance and consistent application.

The predominant activity of health care practitioners continues to be providing service to people already suffering from illness and disease. Very few practices are organized for prevention and reimbursement is not clearly defined. Those practitioners who do consider prevention are largely addressing early detection (mammogram, PSA, biopsies) and secondary prevention such as drug therapy for elevated cholesterol.

I am confident that in time preventive health care will be a common practice. The public, community institutions and health care practitioners will need to be more systematic about prevention, and changes will be required in the financing mechanisms for health. There is good reason to believe the practice of preventive medicine may not be dominated by physicians. Nurses and other practitioners such as nutritionists and fitness instructors can serve well in this capacity. It is conceivable that lifestyle health coaches could be attached to a team trained and organized for primary health care where prevention and risk management are the predominant focus.

Primary prevention at the level of the community offers leverage for the most effective and efficient improvement in health status. The Framingham Project and the North Karelia Project in Finland provide evidence for lifestyle as the origin of chronic heart disease. The North Karelia Project demonstrates how public health intervention at the community level can effectively reverse this process and reduce the incidence of heart disease.

In the 1960s Finnish men had the highest rate for heart disease in the world and the Province of North Karelia had the highest rate in the Finland. The North Karelia Project was originated in 1972 to address this situation. It was a public health intervention to reduce smoking; improve diet by reducing fat and salt, and increasing vegetables and fruit; reduce weight; detect and treat systemic hypertension and elevated cholesterol.

The project demonstrated that a determined and well-conceived public health intervention would change health related lifestyle and population risk factors, and this leads to reducing disease rates and improved health status. By 1995 the incidence of heart attacks had decreased 75% and the incidence of cancer also decreased. Over a span of 20 years the project prevented 3,800 premature deaths in the North Karelia Province.

Some recent comments on this and other health related blogs have voiced skepticism about the effectiveness of preventive health care. Immunizations, smoking cessation, and the Framingham and North Karelia projects provide evidence that prevention and healthy lifestyle are effective. However, there is concern as to how this information might best be implemented in the US. The orientation of the US public and the US health care system is medical intervention with application of technology, drugs and surgery. This diverts resources from public health interventions that would be more effective. Of greater consequence is the distortion and distraction of attention from how best to achieve optimum health.

Medical care treats but does not cure chronic disease. Healthy lifestyles and primary prevention will not avoid all chronic disease but enough to improve health status and quality of life for the population. In turn, this provides high probability to change basic equations and outcomes for society.

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