A new compendium of community based prevention programs released Monday by the Trust for America's Health and The New York Academy of Medicine is designed to help show how certain types of preventive services can yield substantial net savings—"largely because the initial costs are low and the long-term benefits are large," said Jeff Levi, PhD, the Trust's executive director in New York.
Last year, the Trust released a report that found that an investment of $10 per person per year in proven community based programs—to increase physical activity, improve nutrition, and prevent smoking and other tobacco use—could save the country more than $16 billion annually within five years, Levi said. This is a return of $5.60 for every $1 spent.
The new report is sending a message that "a strong evidence base [exists] for prevention efforts . . . as we move toward the goal line of the healthcare reform debate," said Jo Ivey Boufford, MD, the Academy's president. "We do believe that there will be significant improvements in health and significant savings for the health systems by really integrating these kinds of proposals into any healthcare reform proposal."
For instance, heart disease, stroke, and diabetes account for 36.6% of deaths in the United States, but this could be significantly reduced by changing just three risk factors—decreasing smoking, increasing exercise, and improving eating habits, Boufford said.
Despite the high rates of preventable death, investment in prevention has been "historically modest in this country—accounting for only 4% of all healthcare expenditures," said Boufford. "The good news is that community based prevention programs work. Well designed community interventions can change behavior. They help people take responsibility for their health and make healthy choices that reduce both the incidence and severity of disease."
The academy identified 84 articles with evidence showing how community based prevention programs could reduce disease rates or disease progression. Some examples are are:
- In Pawtucket, RI, the Pawtucket Heart Health Program conducted an intervention to educate 71,000 people about heart disease through a mass media campaign and community programs. Five years into the intervention, the risks for cardiovascular disease and coronary heart disease had decreased by 16% among community members.
- Researchers at Ohio State University recruited 60 women in their 40s for a 12 week walking program that took place on the college's campus. At three months, the intervention group reported a 1% decrease in body mass index, accompanied by a 3.4% decrease in hypertension, a 3% decrease in cholesterol, and a 5.5% decrease in blood glucose.
- The Rockford (IL) Coronary Health Improvement Project is a community based lifestyle intervention program aimed at reducing coronary risk, especially in a high-risk group. The intervention included a 40 hour educational curriculum delivered over a 30 day period with clinical and nutritional assessments before and after the educational component. At the end of the 30 day intervention period, analyses of total cholesterol, triglycerides, blood glucose, blood pressure, and weight showed significant reductions.
Recent studies have "questioned the cost-effectiveness of prevention proposals within healthcare reform legislation, [but] we think that there is strong evidence that community based prevention . . . [does] offer a very high return on investment," Boufford said. "By changing the infrastructure in these communities where people live, learn, work, and play, we really can create sustainable change to prevent disease before it occurs and see that return on investment."