An Ounce of Prevention
Among a multitude of major programs for the Washington Health Foundation during its active period of 1992 to 2013 was a Prevention Initiative (for a full recording of our activities and accomplishments, go to washhealthfoundation.org). Our Prevention Initiative was an attempt to bring major attention, investment and collaborative action toward preventing health ills for the people of Washington state. It was supported by a number of Washington state organizations, public and private.
We scored some important health improvement points with the Initiative, but it failed to scale up as fully as we would have liked. The barrier to greater success was not a mystery to us- indeed it was the reason to try. That is, the strong orientation of the medical care system to addressing illness care, even when many of these maladies could be avoided with an ounce of prevention. The medical care system absorbs an inordinate amount of resources and attention to its needs. Changing this pattern was the intent of the Initiative, and while we did some good, we ultimately did not have enough capital to more than marginally change the status quo.
It was not our only attempt to tackle this bear throughout our history. From the Healthiest State in the Nation Campaign to many of our grant making investments to an assortment of programs and activities, the fundamental aim of health improvement, rather than just more medical treatment, was central to our mission. We are satisfied that we made progress, but still disappointed that we could not have achieved more.
Now we find ourselves contemplating some form of a return to the field of play following a mothballing of our activities for several years due to budget limitations. The objective of prevention remains high on our priority list. But how the context around prevention has changed recently- and made the proposition even more daunting than before.
The dominant context being, of course, the virus. The horror of a half million lives lost showed the critical importance of having a medical care system that can respond to mass casualty situations. This justifies the need for great resources, even more than before, in this moment. To be clear, having a robust medical care system was never anything we opposed; only that we needed to invest in building a similarly strong capacity to promote health and prevent disease and injury.
Another consequence of the pandemic is that it is harder to fully embrace the long term thinking essential to a prevention state of mind. Prevention, in most cases, is something with a lagging benefit line. A benefit that seems less important when our view of time gets compressed. Over the past year, our mortality became all too near to most of us. The specter of harm or even death hovered around us, with daily death counts rivaling those of the Vietnam War on the nightly news. Not too surprisingly, our nightly cocktails seemed to be a better reaction to this than a workout which might never yield its long term benefit. Diets? Not now thank you- and please pass the Cheetos.
Also of note is the culture war that has pulled Covid into its ugly manifestations. While the issues are more complex than the concept of prevention, just the noise makes it very hard to get into a prevention frame of thinking. Not to mention that some of the controversy itself revolves around prevention. Look no further than vaccines- a prototype of modern health prevention. Where once such innovations were viewed as a godsend to those who suffered through scourges of contagious disease, now there is a cacophony of doubters and deniers. Despite the fact that these Covid vaccines are some of the most effective in history, and with very low risk of adverse side effects.
There are those waiting for more evidence as it relates to their decision to get a vaccine or not. Or insisting that this is something that is of marginal or no benefit to them, the nation, or the world. Can fear of needles be that high? Perhaps, with a dose of tribal belief systems egging them on.
All these factors make it a strange and more difficult time to press for the adoption of new prevention strategies, including and beyond vaccines. More physical activity. Better nutrition, and lower weight. More fluids, less sugar, regular screenings, and more.
Yet, perversely, maybe it is just the right time. Even as some politicians deny the existence or impact of Covid, they have pointed instead to the ills associated with our poor general health as a counter point to the calls for public health action on the virus. Some rail against the comorbidity of obesity in particular, or other chronic conditions, as an alternative explanation to the severity of Covid. They ask why are we not spending more time addressing these problems rather than the pesky virus. Wouldn’t we tackle these issues if we are truly serious about improving health, and not merely promoting what they view as a political or cultural objective?
I doubt the seriousness of their intent to truly intervene into chronic diseases or to address the personal risk behaviors and social barriers underlying complex issues like obesity. For now, these problems are probably just useful talking points that help spin attention away from the virus and public health measures. But it makes a usable talking point to them nonetheless.
So should those of us who believe in prevention now use the thread of truth in their underlying message. These are real issues to be addressed, with or without the virus. Let’s call their bluff and press for concerted action on invigorated health prevention across our Nation, now and into the future. Maybe, just maybe, the strangeness of our times can lead to something good. Even, ultimately, a leap of our health status for the better.
It is worth dreaming about, even if only with just with a few ounces of good intention during happy hour. And maybe adding a few pounds of prevention through creative thinking and action can make a real difference.
Greg Vigdor
President
Washington Health Foundation