Greater Use of Preventive Strategies Key to Saving Lives: Five Services Vital

Kim Krisberg

Nations Health. 2007;37(8) 


Emphasizing prevention has long been touted as key to avoiding many life-threatening illnesses and curbing out-of-control health care costs, and now a new report has found that just five underused preventive services could, indeed, save thousands of U.S. lives every year.

The lives of more than 100,000 U.S. residents could be saved annually if services such as flu immunizations and cancer screenings were used more often and more effectively, according to "Preventive Care: A National Profile on Use, Disparities and Health Benefits," which was released in August by the Partnership for Prevention. Funded in part by the Centers for Disease Control and Prevention, the report particularly highlighted five underutilized services and interventions: taking a daily aspirin to avoid heart disease; increasing smoking cessation assistance; receiving immunizations against influenza; raising screening rates for colorectal, breast and cervical cancers; and testing more women for chlamydial infection to prevent pelvic inflammatory disease. While such services are being underused across the general population, the report noted even sharper shortfalls among blacks, Hispanics and Asians.

"The cost of keeping the population healthy will continue to rise by rates higher than it needs to be if we're unable to use health promotion, screening and early detection capabilities better than we are," said APHA member Eduardo Sanchez, MD, MPH, director of the Institute for Health Policy at the University of Texas School of Public Health and chair of the National Commission on Prevention Priorities, the group that guided the report's work. "If we do nothing about this now, the challenges facing the health care system will only get worse."

Probably the most accessible and affordable prevention tactic, taking a daily aspirin, could help thousands of U.S. residents ward off heart disease. According to the report, if the rate of at-risk adults who took a daily aspirin increased to 90 percent, 45,000 lives could be saved every year. Currently, fewer than half of at-risk adults take aspirin daily, with only a little more than 40 percent of men ages 40 and older and women ages 50 and older doing so. The lowest rates were among Hispanic, black and Asian adults. While data show the number of at-risk adults who take a daily aspirin moving in a positive direction, the report's authors warned that "annual changes in the data must be interpreted cautiously."

"Counseling at-risk adults to consider using aspirin daily would save about $70 per person counseled, assuming that about 50 percent of people comply with physician advice," the report found.

Taking on smoking, the nation's top cause of early preventable death, could also reap healthful rewards. For years, top health officials have been recommending that health care providers counsel all patients on the dangers of smoking as well as on ways to kick the habit, however the numbers of health professionals offering such advice and assistance is not as high as advocates would hope. In 2005, 27.5 percent of smokers reported that in the past year a doctor, nurse or other health professional had offered strategies to help them quit smoking — the rate was at 27.6 percent in 2004. Almost 48 percent of smokers said a health professional had advised them to quit smoking in the past year, however the report's authors noted that effective cessation counseling also includes offers of assistance. If 90 percent of smokers were advised to quit and offered assistance, 42,000 lives could be saved yearly.

Among the report's other predictions were that 14,000 additional lives could be saved if 90 percent of adults 50 and older got recommended colorectal cancer screenings; 12,000 lives could be saved if 90 percent of adults ages 50 and older got an annual flu shot; almost 4,000 lives could be saved if 90 percent of women 40 and older were screened for breast cancer in the past two years; and 30,000 cases of pelvic inflammatory disease could be prevented if 90 percent of sexually active women were routinely screened for chlamydia.

Minority groups, however, have particularly low usage rates of prevention strategies. For example, Hispanics have lower usage rates than whites and blacks for 10 out of 11 preventive services studied in the report. Asians had the lowest rates of any population group for preventive aspirin use as well as cancer screenings. Also, because of high mortality rates among blacks due to colorectal and breast cancers, raising screening rates could have a significant impact. In fact, if the percentage of blacks 50 and older who currently receive recommended screenings for colorectal cancer were raised from 42 percent to 90 percent, 1,800 lives would be saved annually.

Jonathan Fielding, MD, MPH, MBA, director of the Los Angeles Department of Public Health and a member of the National Commission on Prevention Priorities, noted that because there are so many contributors to disparities in the use of prevention services, it is difficult to pinpoint one overriding factor. However, one way to begin closing the gap is to ensure health promotion and education activities include "culturally relevant and actionable messages that resonate with the population...We have to strike the themes that are most likely going to be embraced," he said.

Fielding noted that while not having health insurance is surely a factor in the prevention disparities reported, having coverage is not necessarily a sign that prevention tactics are being used. No insurance is needed to take a daily aspirin, smokers who do have coverage aren't always counseled to quit and yearly flu shots are often offered around the country at local clinics, he said.

"It would be wrong to give the impression that solving the terrible health insurance problem would solve this problem," he told The Nation's Health. "It would be a useful contributor but it alone is not the sole answer."

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