Farshad Fani Marvasti, M.D., M.P.H., and Randall S. Stafford, M.D., Ph.D. believe there must be a fundamental transformation in the U.S. from the current, expensive model of treating acute illnesses to cost-saving, prevention-based healthcare:
Although the United States pays more for medical care than any other country, problems abound in our health care system. Unsustainable costs, poor outcomes, frequent medical errors, poor patient satisfaction, and worsening health disparities all point to a need for transformative change.1Simultaneously, we face widening epidemics of obesity and chronic disease. Cardiovascular disease, cancer, and diabetes now cause 70% of U.S. deaths and account for nearly 75% of health care expenditures.2 Unfortunately, many modifiable risk factors for chronic diseases are not being addressed adequately. A prevention model, focused on forestalling the development of disease before symptoms or life-threatening events occur, is the best solution to the current crisis.
In last week’s New England Journal of Medicine, Drs. Marvasti and Stafford argue:
The organizational structure and function of our medical system is rooted in fundamental changes made at the beginning of the 20th century that emphasized an acute care approach and marginalized prevention and public health. Breakthroughs in laboratory sciences led by Koch and Pasteur provided powerful tools for mechanistically understanding and treating infectious diseases. Bolstered by philanthropy and the Flexner report, U.S. medicine became reliant on laboratory research.4 This strategy made sense 100 years ago, given the prominence of acute infectious diseases in a young population; it makes little sense now.
Prevention of so many chronic adult diseases obviously begins in childhood. A proper diet, an active life, and a healthy mental attitude are what most parents try to instill in their children. And the best role-models are parents themselves. If our kids grow up watching their parents smoke, or drink sugar at every meal, or drive without seat belts, or scream or hit or use profanity, or, whatever else triggers their “BS” detectors, then it really doesn’t matter what we tell them, does it?
Pediatricians can do their best to educate parents and children. Teachers can develop students’ skills for critical thinking and problem-solving. Politicians can legislate desirable social behavior all day long (and talking heads can debate the loss of personal freedoms). But the bottom line is that prevention starts in childhood, it starts at home, and it is learned, first and foremost, from parental behavior.
Read this important article here: