This circle graphic, on the cover of the 2011 National Prevention Strategy, represents the topics covered and goals established by the comprehensive plan to increase the number of Americans who are healthy.

Plan Focuses on Environment’s Impact on Wellness

An early keystone of the Obama Administration’s Affordable Care Act was the release in June of the “National Prevention Strategy,” a comprehensive plan to increase the number of Americans who are healthy at every stage of life. For clinicians who have devoted their careers to preaching the benefits of healthy living, the strategy couldn’t have come soon enough.

“I don’t think that what the strategy is advocating is all that mind-changing or dramatic. It’s things that we in the prevention community have been talking about for years,” said Mark B. Johnson, MD. “What makes it a milestone, though, is that now the discussion has been raised to a national level, and most of the cabinet-level agencies are now focusing on it and talking about it and meeting on it and thinking about it. So it has raised the ‘backwaters’ of medicine to a national level, and I think that truly is a milestone.”

Johnson has been the executive director of public health and environment in Jefferson County, Colo., since 1990 and recently completed his term as president of the American College of Preventive Medicine. Founded in 1954, ACPM is the national professional society for physicians committed to disease prevention and health promotion. Specialists in preventive medicine are uniquely trained in both clinical medicine and public health.

Johnson’s interest in preventive medicine began during his years at Le Moyne University and was honed during his three years in general practice in a small Colorado community. Those three years were pay back for a medical school scholarship from the National Health Service Corps, and they changed the direction of his career. “I learned that there’s more to this than just taking people who are sick and making them feel better,” he said. “We should be doing something to help prevent some of this stuff.”

That’s just what the National Prevention Strategy is all about. “Congress wanted to send a clear message about the importance of prevention for maximizing positive health outcomes and saving costs,” explained Janet L. Collins, PhD, associate director for program at the Centers for Disease Control and Prevention. The CDC is one of 17 federal agencies that consulted with outside experts and stakeholders to develop the 125-page strategy.

“Perhaps the most fascinating thing about this project is that it’s a collaborative endeavor of departments like Transportation, Education, Agriculture, Justice, as well as Health and Human Services,” Collins said.

Perhaps its most revolutionary feature is that the strategy acknowledges that good health comes not just from receiving quality medical care, but also from clean air and water, safe worksites and healthy foods. “There’s a recognition that health is built by more than what happens in a doctor’s office. It’s built by more than what the health sector controls,” Collins said. “Health in the country is built by quality housing, quality and affordable food, issues around employment, and all of these pieces really contribute to health in the country.”

The National Prevention Strategy suggests actions that both public and private partners can take to help Americans stay healthy and fit— and therefore improve the country’s prosperity. The strategy outlines four strategic directions:

1. Building healthy and safe community environments. Prevention of disease starts in communities and at home, not just in the doctor’s office.
2. Expanding quality preventive services in both clinical and community settings. When people receive preventive care, such as immunizations and cancer screenings, they have better health and lower healthcare costs.
3. Empowering people to make healthy choices. When people have access to easy-to-understand information and have help setting easy-to-achieve goals, they are empowered to make healthier choices.
4. Eliminating health disparities. By eliminating disparities in achieving and maintaining health, the quality of life for all Americans improves. 

“We like to think about it as making a healthy choice the easy and attractive choice,” Collins said. “If you’re in a worksite situation where the only available foods are out of a vending machine and those choices are not very healthy, you’re limited by the choices that surround you in many ways. If it takes a two-bus ride to get to the full-service grocery store with fresh fruit and vegetables, chances are you aren’t going to make use of that.”

So-called “food deserts” are a particular problem in inner cities, where convenience marts may be the sole sellers of groceries for miles in any direction. This challenge contributes to health disparities. “I think sometimes there’s a feeling that these differences are intractable, but it’s pretty clear that when we focus on them and work specifically to eliminate health disparities that it is indeed possible,” Collins said. “My takeaway is to really involve the communities themselves that are experiencing these disparities, to be part of the solution and figure out what will work and what is affordable and what is sustainable.”

Both Collins and Johnson maintained that a key to implementing the strategy’s far-reaching recommendations indeed rests with communities. To a certain extent, that means local and state public health departments. “The problem with local health departments is, when you’ve seen one, you’ve seen one,” Johnson said. “Here in Colorado, we’ve tried to move to where we have more of a blanket of public health instead of a patchwork quilt, but nationwide, we still really have a patchwork quilt of public health agencies.”

Nonetheless, Johnson said local public health overall is in a position to encourage community improvement. Yet when it comes to individual patient improvement, not so much. That’s where physicians must step in, he said.

“I think the biggest thing that the Accountable Care Act and the National Prevention Strategy will do for the practicing clinician is try to broaden the mindset away from just me and my patient to me and my community,” Johnson said.

While acknowledging that this paradigm shift won’t happen overnight, Johnson contended that practicing physicians “have always known” that the environment and community conditions impact their patients’ health. The trick now is to pave the way for physicians to be compensated for preventive medicine services and held up in communities as authoritative voices for change. “Their word is so weighty in terms of impact,” he said. “It’s a natural.”

Thus, “broadening the scope of what a physician does and thinks about” should be a catalyst for health improvement and cost containment, Johnson noted. “If that’s all this strategy does, gets physicians to broaden their focus away from just the patient they are seeing in the exam room to how the community impacts this patient and what physicians can do to help in that arena, it will be a big success.”

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