State of Prevention in Allied Health Education and Practice, The

Journal of Allied Health, Fall 2004 by Sportsman, Susan, Hawley, Linda J, Bowles, Betty

HEALTH CARE COSTS, representing 13.3% of the U.S. gross domestic product in 2000 and 14.1% in 2001, remain a major barrier to providing adequate access to care. Escalating costs have been fueled primarily by spending for prescription drugs (15.7%), hospital services (8.3%), and physician and clinical services (8.6%),1 most of which are likely to be associated with illness care. Outcomes of care in the United States do not compare favorably with other countries committing similar resources to health care. The United States spent $4,000 per person in 1998 compared to $2,860 by Switzerland, the nation that ranked second in health care spending. Yet Americans lived an average of 77 years compared with the Swiss life expectancy of 80 years. Similarly, Canada and Japan, both with average life expectances of 81, spent $2,363 and $1,763 per person. There has been some benefit to the increased U.S. spending because the average life expectancy has increased from 70 to 77 years over the past 4 decades; however, the United States still falls behind other industrialized countries in the cost of health care relative to longevity of the population.2

Prevention (health promotion and risk reduction) has been touted as an important strategy to reduce health care costs. The underlying principle of such an approach is that the cost of prevention or early treatment would be less than the cost of aggressively treating a serious illness. Prevention can be accomplished only if all health care providers, regardless of discipline, integrate health promotion/risk reduction into their practice. This article reviews the state of prevention in allied health education and practice and discusses the experience of a College of Health Sciences and Human Services in encouraging integration of prevention into allied health practice.

Emphasis on Prevention

Since the 1970s, there have been significant efforts from governments and a variety of health care advocates to integrate prevention into health care. In 1979, the SurgeonGeneral's reports, "Healthy People" and "Healthy People 2000: National Health Promotion and Disease Prevention," established national health objectives that served as a basis for the development of state and community plans.3 Under the direction of the U.S. Public Health Services, the "Healthy People 2000" goals have been replaced with "Healthy People 2010" goals, revised to include (1) increasing life expectancy and improving quality of life and (2) eliminating health disparities among the U. S. population.4

Prevention also is receiving increased attention internationally. The objective of the Department of Noncommunicable Disease Prevention and Health Promotion of the World Health Organization is to reduce the incidence of noncommunicable diseases and promote positive health and well-being, with particular focus on developing countries. The strategy to reach this objective is to emphasize major risk factors for noncommunicable diseases and the underlying determinants of health.5 Similarly the goal of the PanAmerican Health Organization includes promotion of primary health care and expediting health promotion to help countries deal with health problems typical of development and urbanization, such as cardiovascular diseases, cancer, accidents, smoking, and addiction to drugs and alcohol.6

SPECIFIC GCWERNMENTAL INITIATIVES

In 1984, the U.S. Public Health Services established the United States Preventive Health Service Task Force (USPHSTF). This independent panel of experts in primary care and prevention, now under the auspices of the Agency for Healthcare Research and Quality (AHRQ), reviews evidence of effectiveness and develops recommendations for clinical preventive services. Similarly, the Centers for Dis ease Control and Prevention (CDC) sponsor a task force on community preventive services and publish the "Guide to Community Preventive Services."7 Both initiatives are designed to determine under what circumstances prevention/risk reduction strategies should be implemented and the standard of care for each intervention.

PRIVATE INITIATIVES

Health care payers have increasingly emphasized prevention. The National Commission on Quality Assurance (NCQA), an independent, nonprofit organization charged with evaluation of quality of the nation's health plans, compares health plan performance with benchmarks set through the Health Plan Employer Data and Information Set (HEDIS). HEDIS is a tool that measures provider performance in particular areas of care, including delivering preventive service.8 More than half of the HEDIS indicators focus on health promotion/risk reduction strategies. The NCQA also has developed a plan to help employers determine revenue savings from choosing health plans that focus on employee health. The Quality Dividend Calculator is a free, interactive, online tool that allows employers to estimate indirect cost savings through increased productivity and decreased sick days/wages through health promotion/risk reduction activities.9 Both of the NCQA initiatives highlight the role of health promotion/risk reduction strategies in delivering cost-effective health care.