Can Preventive Care Change Unhealthy Behavior?

Dana Blankenhorn over at ZDNET Healthcare posed a provocative question on his blog: “Is preventive care a silver bullet against rising health care costs?” If individuals have access to the knowledge they need to make the right decisions, will they in fact take greater responsibility to maintain their health and thus avoid many preventable illnesses? It seems that any proposal to reform healthcare in America is counting on it. As an example, here is an excerpt from “Call to Action, Health Reform 2009” written by Senate Finance Committee chairman Max Baucus (D. MONT.)

“The Baucus plan would immediately refocus our health care system toward prevention and wellness, rather than on illness and treatment. Those who are uninsured ― and therefore less likely to receive preventive care and treatment for major conditions ― would be given a “RightChoices” card that guarantees access to recommended preventive care, including services like a health risk assessment, physical exam, immunizations, and age and gender appropriate cancer screenings recommended by the U.S. Preventive Services Task Force.”

We agree with Sen. Baucus that focusing on prevention and wellness is an essential part of meaningful reform. But there is no silver bullet unless there is a significant shift in people’s attitudes about their own health. What if individuals could be given a custom health plan based on their genes and family history? As Blankenhorn asks in his blog, “Will we follow it? And what will following it cost, as opposed to waiting for your stroke, having a good time, and then dieing suddenly in middle age?”

Unhealthy behavior is a way of life in Huntington W. Virginia.

A recent CDC study of U.S. health claims that this out of the way college town has the dubious distinction of having the poorest health ranking in the country. Nearly half the adults in the five county metro area of Huntington are obese, far higher than the national average. Huntington also leads in 6 other illness measures including heart disease and diabetes. It even tops the percentage of adults who have lost all their teeth (half of them have). This is in sharp contrast to another out of the way college town—Burlington VT—ranked by the CDC as the healthiest city in America in 2008.

Huntington and Burlington share similar attributes of both being college towns and both having overwhelming white populations of English, Irish or German ancestry. But there the similarities end. Burlington is younger, better off financially (8% living at federal poverty level vs. 19% in Huntington) and better educated (40% have at least a college degree vs. 15% in Huntington). These differences, coupled with regional cultural differences help to explain why Huntington’s adult population is not only unhealthy but has little motivation to improve.

In Huntington, high unemployment and the high poverty level combine to make even basic health care services unaffordable. In Burlington, IBM, the area’s largest employer, influences good health through its insurance plans and well funded wellness initiatives. In Huntington, many people think of exercise and healthy eating as luxuries. In Burlington they are considered the norm.

While the poor health rating for the Huntington area is a terrible distinction, the locals rarely talk about it. In fact, follow up surveys showed that most people weren’t aware of it. And when made aware, most saw little reason to change their behavior.

Huntington is a perfect candidate for applying behavioral economics to change the health status of a population. By identifying biases that lead to bad health decisions, health providers and community agencies can exploit these biases by making the healthiest choices the ones that follow the path of least resistance. For example, fast food is a major food supply for residents who believe they can’t afford to buy healthier food. Fast food restaurants could apply behavioral economics by substituting bottled water for soda as the default beverage with a combo meal. The soda would be available only on request.

Gabe d'Annunzio

Truth in Comedy

My favorite comedian is Brian Regan and if you watched the above video you'll see "truth in comedy" certainly exists as he tackles his high cholesterol and feelings of inferiority when visiting his doctor.

But as Carol Burnett once said "comedy is tragedy plus time." And our country is heading for tragedy with regards to health care. It's not just that people don't listen to their doctors - they also aren't going - especially if they perceive it's more important to fill their cars with gas and put food on the table vs. paying for prescriptions or doctors visits. In a recent article in the WSJ (Consumers Cut Health Spending as Economic Downturn Takes Toll 9.22/Vanessa Furhmans)

As the credit crunch threatens to throw the economy into a deep slump, Americans are already cutting back on health care... Health policy experts say patients short term care cutbacks could lead to more medical problems and higher spending down the road.

Here are some more alarming statistics from this article.

According to National Association of Insurance Commissioners, 11% of consumers surveyed said they scaled back on prescription drugs to save money. And 22% said the economy is causing them to go to the doctor less often.

The truth is unless people change their behavior and play an active role taking care of their own health, there will always be a health care crisis (sicker people = increased health costs for everyone). Yet, as organizational behavior specialists would say you can't change behavior without metrics. In other words, Brian Regan and others might decide to do something about their high cholesterol if they had incentives to do so. People might make the choice to fill their prescriptions if they were less costly. And they would certainly take their meds if they knew not taking them would cause them to pay a higher premiums on their health care. The bottom line is - incentives change people's behavior - and as Ruth Buzzy would say - "That's the Truth."