Prevention Nation: When Health Care 'Takes Over' The Government

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It's an unsung and little-known piece of Obamacare — even though it is beginning to permeate our government, and it aims to permeate our lives (in a nice, non-Orwellian way, that is) and it may be our best hope for reining in the country's skyrocketing health costs.

It can be summed up in a word: Prevention. To wit: It is far, far better to keep people healthy than to treat them when sick — especially with our staggering rates of chronic disease, such as this week's statistics on the soaring rates of diabetes. To that aim, thinking about health has to inform government policy across the board — even in agencies that seem to have nothing to do with it.

You've likely heard of the free preventive care, from checkups to vaccines, that Obamacare requires. But this gets even bigger than that. Obamacare expert John McDonough of the Harvard School of Public Health calls the prevention piece one of the most visionary and long-term-important parts of the law.

[module align="right" width="half" type="pull-quote"]You think, 'Oh my God, this is an attempt by the health care people to take over the universe,' but it's actually the opposite.[/module]

"What's interesting about it," he said, "is that it is the first major federal effort at crafting an approach that is referred to as 'health in all policies,'" an international concept for infusing preventive health into all government policies, from transportation to housing to education.

"If you first look at it, you think, 'Oh my God, this is an attempt by the health care people to take over the universe,' but it's actually the opposite," he said. "It's an approach that says that by incorporating a preventive health mindset into all of these other domains, you can dramatically decrease the size and cost of health care in the United States."

"I think this is the future of how we're going to fix health care," he said.

He offered an example: The "Green and Healthy Homes Initiative." The Department of Energy wants to weatherize the nation's homes, but in many low-income neighborhoods, sealing in the heat also seals in triggers of asthma, lead poisoning and high blood pressure. So if the unhealthy factors are fixed at the same time, you lower not only energy costs but medical costs. "The health people, housing people and energy people working together: That's a 'health in all policies' approach," he said. "That's what the national prevention strategy is all about."

If this country did royalty and we had a Queen of Prevention, that would be Dr. Regina Benjamin, the surgeon general of the United States and thus "America's doctor." (No, it's not Mehmet Oz.) She leads the new National Prevention Council created under Obamacare, and was recently in Boston to receive an award from the health policy institute NEHI. Our conversation, lightly cut and edited:

Dr. Benjamin: The National Prevention Council is made up of 17 cabinet-level members, who are all focusing on prevention. The Department of Health and Human Services secretary, the secretary of education, secretary of housing and urban development, the VA, transportation, the USDA. All these cabinet-level members are sitting around the table now, looking at health and wellness from a prevention standpoint, and this is the first time ever.

The council released the first-ever national prevention strategy and the goal of the strategy is to increase the number of Americans who are healthy at every stage of life, whether you are two or 92. We want you to be healthy and our mission is to move our health care system from a focus on sickness and disease to a focus on wellness and prevention. With this national prevention strategy we're engaging all parts of our society, everyone from individuals to companies to government to local governments, churches, community and faith-based organizations.

If Obama had lost and the Affordable Care Act had been repealed, would this not have been going forward?

I believe that the prevention movement will go forward, because it's common sense. If we can prevent you from getting sick in the first place, we're better off.

I think it would go forward, but it’s easier to go forward with a strategy, a foundation in place. The strategy is really the vision, a roadmap, on how to become a more healthy and fit nation. We basically can do what we can with the federal government — we want to set an example for the rest of America, for the cities and states. Others are starting to adopt the strategy, and that's what our goal is.

So paint me a picture: If a child born today benefits from everything you're planning — how would their life look different?

[module align="right" width="half" type="pull-quote"]Health isn’t something you think about once a year when you go to the doctor. It’s in everything.[/module]

The first thing: They'd be happy. They'd be enjoying being healthy, and they would look at health as fun and as enjoyable, and not as a burden or something you have to think about. It's something that you are. It’s something that's part of you, so health and wellness is in everything that we do: It’s in where we live, where we learn, where we work, where we play, where we pray. It’s in everything. And so health isn’t something you think about once a year when you go to the doctor. It’s in everything. And so that kid would just grow up with that healthy environment, with that healthy outlook on life.

So what would that look like?

They would be eating healthy foods that taste good, not just ones that taste pretty rough. They'd be playing and dancing and flying kites, riding bicycles, walking, enjoying being physically active as part of their everyday lives. And having good relationships with friends and family and parents, as part of a healthy community.

You’re so positive, but let’s get a little negative, because to promote health, the big battle is to counteract the commercial influences that have gotten us where we are today.

It's hard for me to be negative, because I think it's important that we be positive. And when it comes to commercializations involving corporations and industry, they need to be part of the solution. So just telling them how bad they are is not going to do that. They know how bad they are. I don't have to be the one to tell them.

But what I can do, they have expertise that can help us find solutions. Most of these companies are in business to make a profit and if we as customers and consumers want healthy products, they’re going to provide those healthy products. The idea is to make them part of the solution so they can create some of those healthier options. They’re part of the community as well.

When I think about the tasks involved in prevention, particularly in terms of obesity and eating, and I think about it from an individual level, I just think it's so very hard. It's so hard to get yourself to work out and to get yourself to eat right. So what can the federal government really do to make me make the right decisions on those things?

It can be hard but it doesn’t have to be hard. The choices right now are pretty hard. We have to make the healthy choices those easy choices. So for example, if you go into a convenience store, it’s hard to find healthy things there. We can put healthy things there to make it easier.

U.S. Surgeon General Regina Benjamin
U.S. Surgeon General Regina Benjamin

To walk — it’s oftentimes not easy to find safe walking spaces and places to ride your bike. We in the federal government can make those routes and make it easier to make those choices easier. It's still your choice, but it's easier to make those choices.

So that's what the Department of Transportation can do?

One thing transportation is doing is they have a program on safe routes to school, called 'Walking Schoolbus" — parents pick up kids and walk them to school. Housing and Urban Development are making their low-income housing units tobacco-free --- and not just the unit but the entire building is tobacco-free, and they have people on their waiting lists that want to be in a tobacco-free building. And the USDA has the My Plate program.

The Department of Defense is doing a number of things within the military, making the military bases and hospitals baby-friendly, tobacco-free programs on bases. They have something for food I call traffic lights — red, green and yellow symbols so the soldiers can easily know what they're eating and make better choices.

Just to be the skeptic, these all sound wonderful but I feel like they’re tiny drops in the bucket against the obesity epidemic that’s been sweeping our nation...

We didn't get here overnight. It took us time. And over time we got here. We have bad habits. and to change habits takes time and it takes little movements, little things that make those changes, that begin to add up.

No one likes to be told what to do. So if you told me I could never have ice cream again, then even as a child you're going to rebel. Se we start doing small things, make those small changes, and we can move toward a more healthy society.

Everyone knows we should exercise, eat healthy, not smoke. Anything you think people might not know?

Mental health is just as important — so trying to decrease the stress in your life, taking time to relax, that's very important to your overall wellbeing. Getting enough sleep — we don't think about how important sleep is, and as you start to get more sleep, it really changes how you feel every day, how you function. And drinking more water — most of us don't get enough water.

So overall, is prevention gaining a level of federal attention or commitment it’s never had before?

Thanks to the Affordable Care or Obamacare, we are now looking at health with the goal of prevention, of changing our health care system from one based on sickness and dsease to one based on health and wellness and prevention. And that is common sense, that we can do it. It’s not money that we need to do that, it’s just our own mindsets, our own will to be healthy. That's a different mindset for individuals but it’s one that I think can be fun and can be enjoyable.

And so I have this idea of a 'journey to joy.' When we talk about health and wellness, when we talk about obesity, we should be positive and I hope people will find their own health care joy, and their own joy in being healthy.

What brings you joy in health might be different from me. One person might want to run a marathon. Another person may want to just fit into an old pair of jeans. Yet another person may simply want to be able to sit up all afternoon to be able to play with their grandkids. Whatever your personal joy is, you find that joy and our role in government is to help you get there.

So we're talking about a cross-agency government commitment to wellness that is unprecedented?

It is unprecedented.

We're trying to be innovative and find new ways to reach people. We can't just write a report and put it on a shelf. So with our walking and exercising and fun things we're doing, like dancing and Zumba, we try to involve people. Everywhere I go, to towns and events, we try to have a walk or some kind of activity.

So Zumba's part of your job now?

Whatever the community wants to do --- we're trying to reach people where they are.

Everything you say makes total sense, but you're also constrained by politics. If you were queen and had no constraints, what would you do that you can't do now?

I don't see barriers. I see opportunities. And so i think it's really important that we give people the will to want to do it. We don't want government telling us we're having fun. We want to have fun on our own.

Readers? If this is the nanny state, I'd say it's Mary Poppins. What do you think?

This program aired on November 16, 2012. The audio for this program is not available.

Carey Goldberg Twitter Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.