Balancing Treatment of Disease and Promotion of Health

Health is largely a result of positive lifestyle behaviors that are often challenging to change. Addressing issues such as smoking, obesity, substance abuse, and inactivity can reduce premature death by 40% (McGinnis et al., 2002; Schroeder, 2007). Positive lifestyle behaviors not only prevent premature death but also extend the average life expectancy by 14 years (Khaw et al., 2008). Currently, approximately 4 cents of every dollar spent for health care goes toward prevention and public health, with 96% spent on treating established disease (Lam-brew, 2007). Two thirds of chronic disease is behavior related and could be mitigated by working interprofessionally to help guide patients toward healthy choices (McGinnis et al., 2002).

Behaviors that have the greatest impact on preventing chronic disease and its progression are (1) reducing exposure to toxic substances (tobacco, alcohol, drugs, pollution), (2) movement and exercise, (3) healthy diet, (4) psychosocial integration and stress management, and (5) early disease

Time-

Figure 2-1 Profit in the current U.S. health care system is obtained focusing on the right of the curve. Investment toward the left of the curve will reduce disease burden and cost over time.

Time-

Figure 2-1 Profit in the current U.S. health care system is obtained focusing on the right of the curve. Investment toward the left of the curve will reduce disease burden and cost over time.

detection and intervention (Jonas, 2009; McGinnis, 2003). For these behaviors to have an impact, the health home will need to be financially supported and have the goal of health as its primary focus. This will require new forms of funding that go beyond the disease-focused throughput model of payment. A primary care clinic that only works from this model will encourage shorter office visits while promoting reliance on expensive technology that often suppresses symptoms without addressing its cause. The health home will push the curve in Figure 2-1 to the left and will involve professionals who specialize in health promotion (or creation) to flatten the curve and reduce the need for the "disease care" teams currently well established in the tertiary care setting.

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