Prevention Is a Hard Sell

The latest report to be issued on the state of health in Massachusetts just came out. If you want the details, the Globe did a writeup that covers some of the key points. There are many areas in which the Commonwealth is doing well, and many areas sorely lacking, but ultimately it all comes down to the money.

According to the report, Massachusetts spends $63 billion on medical services and $600 million on public health (which includes prevention). So in total, the amount that we spend to prevent medical issues is less than 1% the amount that we spend to treat them after they occur. Due to the Commonwealth's tight budget, the relative percentage has actually gone down over the past few years.

What might happen if you doubled the amount spent on prevention, so that it's maybe up to somewhere around 2% of the money we spend on treatment? Over time, the population will be healthier and expenditures on treatment of preventable illnesses will go down.

For example, take Codman Square in Dorchester. There's no supermarket there, but there is a fast food restaurant. There are some parks where people can exercise, but they're not always safe so many people don't. Some money to bring in fresh, healthy food and make the streets and parks safe would be a great way to make the people of Codman Square healthier. In particular, the rate of obesity and diabetes might go down.

Now, prove that there's a return on the investment. How exactly would I show that those people who now don't have diabetes would have developed diabetes if that money hadn't been spent? There are very few feasible ways to do it. How would you prove that something that could have happened didn't due to something that you did?

The thinking about prevention is completely backwards. Why isn't improved health an outcome worth funding? Instead of looking at health as an absence of disease, why not think of it as a presence of proper body and mind function? The return on investment will come, but it will really be from the increased productivity of healthy people and not from an illness that didn't happen.