When we take a long view on improving health, we usually find reasons to celebrate. In the last century, for example, infant mortality dropped by 90 percent and maternal mortality decreased 99 percent. Yet today, despite scientific advances, we face the fact that we are not a healthy nation:
– Our children’s life expectancy may be shorter than our own.
— About 70 percent of deaths and health costs in the U.S. are now attributable to chronic diseases (e.g., cardiovascular disease, cancer) — many of which are preventable.
— More people die from obesity or tobacco than from homicide.
Our health care system has gravitated toward quick fixes rather than the persistent actions with lifetime rewards. Proven clinical and community preventive services go unused. Two out of three adults fail to get a flu vaccine or recommended colorectal screening. Millions of lives are lost needlessly. As a nation, we dedicate only three percent of our health dollars on health promotion — but over 20 percent of costs to the last year of life.
A new approach is needed. As part of its overall plan to fix the fundamentally flawed health system, the Center for American Progress proposes a Wellness Trust. The Wellness Trust would:
– Deliver prevention outside of the bounds of the health system by paying for services wherever they are delivered, in pharmacies or supermarkets, workplaces or senior centers.
— Use its pooled financing to create incentives for providers, employers, schools and individuals to prioritize prevention.
— Operate independently like Social Security, with expert Trustees.
The premise of the Wellness Trust is that disease prevention is more like homeland security than health insurance: everyone needs it, no one notices if it works, and it depends on persistent, strong leadership and systems. While change will come at a cost, this cost would be dwarfed by the lost lives, productivity, and public resources that will result from a failure to act.