Introduction

The cost of U.S. healthcare affects all Americans. From healthcare consumers, to health insurance purchasers, to policymakers,  to employers, to employees, as the Affordable Care Act implementation gets underway, the healthcare price-tag touches all of us in some way. Everyone wants great healthcare outcomes at a good price, but research shows that American healthcare often delivers the opposite: care is very expensive and our health outcomes fall short of those of other high-income countries.

The Health Policy Institute of Ohio published a report titled “Ohio Prevention Basics,” as a part of its Policy Basics series, to explore the meaning of “preventative health,” and to take a closer look at how America, and Ohio, may be able to realize value, measured financially and in quality-of-life, by increasing emphasis on preventative health. Perhaps not surprisingly, the reports suggests that preventative and population-based perspectives are most cost-effective when employed beyond traditional clinical healthcare settings and across geographic and commercial sectors.

This briefing summarizes some of the findings in the Ohio Prevention Basics report. The entire report is available here.

Summary

What is Prevention?

Preventative care is designed to reach and assist people before they become ill. Because prevention precedes acute illness, preventative health activities can take place in a wide variety of places, including public health departments, traditional healthcare settings, the workplace, schools, and the legislature. Preventative care can more easily reach large groups of people (i.e. communities like schools, churches, or workplaces or geographically-defined populations like cities or counties). For example, a workplace wellness program may incentivize employees to make healthier lifestyle choices; children may receive education in school about healthy food and exercise options that decrease the chance that as adults they will develop diseases secondary to sedentary lifestyles; and the state legislature may pass a smoke free workplace law to dissuade smoking at work and to protect employees from the negative health effects of second-hand smoke.

What Determines Health?

Most people are familiar with the effect traditional clinical healthcare has on overall health. Overall health outcomes, however, depend not only upon access to quality clinical healthcare, but also upon individuals’ health behaviors, socioeconomic factors, and physical environments. When assessing the health needs of a population, a community, a business, a family, or an individual, each of these factors plays an important role. Furthermore, interventions occurring prior to the clinical healthcare setting can more easily prevent or delay the onset of debilitating illness.

Who Affects Health?

In a prevention-centered health paradigm, it is not just clinical care providers who can positively affect health. Individuals and groups in all social and commercial sectors can play a role by offering infrastructure and incentives that encourage healthy lifestyles. Furthermore, preventative services delivered within the traditional clinical healthcare system are frequently less cost-effective than community- or population-level preventative services.

Community- and population-based prevention are generally not funded by clinical care dollars. Preventative community health dollars come from all levels of the government and from philanthropic funding. Population health, which is most often effected through legislative and other policy initiatives, enjoys cross-sector funding from areas like education, transportation, and regional planning in addition to government and philanthropic backing.

How Does Ohio Measure Up?

When compared to other states, Ohio ranks 37th in life expectancy, 42nd in overall health outcomes, and spends more per capita than 32 other states on healthcare. Further research is needed regarding precisely how much money Ohio spends on preventative health. 

Ohio prevention programs are largely carried out by the clinical healthcare system, governmental public health and human services agencies, and private nonprofit organizations. Employers are also involved with prevention, including providing and subsidizing employer-based health insurance and through the adoption of workplace wellness programs.  

Conclusion

Prevention is an important, though often overlooked, component of health in our communities. Health behaviors, socioeconomic factors, and the physical environment all have a significant effect upon health and may be positively influenced by people, entities, organizations, and policies not usually considered a part of traditional clinical healthcare settings. Populations, communities, businesses, families, and individuals seeking to improve health, whether on an individual or collective basis, should consider creative, prevention-oriented solutions as a cost-effective way to supplement and strengthen existing clinical health resources.