Letter From the Lipid Spin Editors: Let’s Not Confuse Health Care Cost and Health

Let’s not confuse health care cost and health. Health care cost is the amount of money spent predominantly for the diagnosis and treatment of people with an acute illness or a chronic disease. The cost is related to the number of encounters and the cost per encounter. It is estimated that one third of health care costs are related to unnecessary care. The Affordable Care Act is aimed at improving the efficiency of the system, providing higher quality of care at a lower cost and ultimately eliminating unnecessary care. This plan may achieve the immediate goal of decreasing cost but it will be ineffective in controlling cost in the long term. The epidemic of obesity will result in an increased number of people with chronic diseases who will require cost effective care.

According to the 2011 America's Health Rankings, Delaware is the 30th healthiest state in the United States. The basis of health is not the effectiveness in caring for the sick but the prevention of people at risk from the development of chronic disease. The factors that contribute to the development of chronic disease include individual behaviors such as the prevalence of smoking, binge drinking and obesity. There are community and environmental factors such as the incidence of violent crime, the number of children who graduate high school, the quality of air, the number of children in poverty and the prevalence of infectious diseases. There are public and health policies such as lack of health insurance, and availability of immunization. The last is clinical care, which includes prenatal care, preventable hospitalizations and the availability of primary care physicians.

To achieve health and decrease the number of people who will require health care requires a co-operative effort on the part of clinical care, the development of public policy focused on improving health, and improving community and environment factors. Ultimately, health is the responsibility of the individual.

At the end of the 19th century and the beginning of the 20th century an alliance of public health, labor, and social and housing reformers were able to remove garbage from the water and address unfair labor practices. Hibbert Hill in his 1916 book The New Public Health noted "The old public health was concerned with the environment; the new is concerned with the individual." The recent New York City ban on the size of sugar containing beverages was a challenge to corporate and industrial practices that place profit above public health. This was reversed because the New York City Board of Health is an administrative agency, which can do only what is authorized by the legislature. Physicians deal with one patient at a time, but legislatures set the standards for community health and the path to follow to achieve health.

Dr. Frieden, the director of the Centers for Disease Control and Prevention, addressed in the May 16, 2013 issue of the New England Journal of Medicine Government’s Role in Protecting Health and Safety. "Government has a responsibility to implement effective public health measures that increase information available to the public and decision makers, protect people from harm, promote health, and create environments that support healthy behaviors. Opponents of public health action often fail to acknowledge the degree to which individual actions are influenced by marketing, promotion, and other external factors."

Have we, citizens, legislators, and elected officials effectively partnered to legislate, educate and encourage individuals to choose a path toward health and not chronic disease?