Explain the focus of the U.S. health care system on treatment of disease compared to disease prevention /health promotion.

Surgeon General’s Perspectives

774  Public Health Reports / November–December 2011 / Volume 126

THE NATIONAL PREVENTION STRATEGY: SHIFTING THE NATION’S HEALTH-CARE SYSTEM

I know the pain and hardship that can strain a family when they experience the loss of a loved one. I lost my mother to smoking-related lung cancer, my father to a stroke, and my brother to human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), all of which are preventable diseases. It is my mission to keep other Americans from having to experience such preventable losses. For this reason, it is my hope to pioneer our nation’s first-ever prevention movement. The National Prevention Strategy,1 called for in the Patient Protection and Affordable Care Act,2 will shift our nation’s health-care system from one based on sickness and disease to one focused on prevention and wellness. We need to stop diseases before they start and allow all Americans to be healthy and fit.

The health and vitality of Americans are critical to the productivity and innovation essential for our nation’s future. Students who are healthy and fit come to school ready to learn; employees who are free from mental and physical conditions take fewer sick days, are more productive, and help strengthen the economy; and older adults who remain physically and mentally active are more likely to live independently.1 Therefore, we need to weave disease prevention into the every- day fabric of our lives, including where we live, work, learn, and play.

Although the U.S. spends more on health care than any other country, our nation ranks lower than several other nations in life expectancy, infant mortality, and other healthy life indicators.3 Our government is striv- ing to change our health-care system for the better, and prevention is essential. A 2006 study by Maciosek et al. determined that increasing the use of preventive services—including tobacco cessation screening, alco- hol abuse screening, and aspirin use—to 90% of the recommended levels could save $3.7 billion annually in medical costs.4 Shifting our nation’s focus toward preventive health will not only result in cost savings but, more importantly, will save and improve lives.

STRATEGIC DIRECTIONS AND PRIORITIES

The National Prevention Strategy is a guide for our nation to provide the most useful and attainable means

for leading a healthy lifestyle. This comprehensive plan encompasses four strategic directions that serve as the foundation for all prevention efforts.

Healthy and safe community environments Our nation must build healthy and safe community environments. Health should be omnipresent and universal—in our homes, schools, and workplaces. By enhancing the quality of our nation’s air, land, and water, we can lessen people’s exposure to environmen- tal hazards and the associated risks of these exposures on health. By designing and promoting affordable, accessible, and safe housing that is free from toxins, hazards, and pollutants, we can give all people an equal opportunity at healthy living.

Clinical and community preventive services We must maintain and enhance our clinical and com- munity preventive services. We know that when people receive preventive care, such as immunizations and cancer screenings, they have better health and lower health-care costs. For example, by focusing on improv- ing our nation’s cardiovascular health, we can save tens of thousands of lives each year. While preventive services are traditionally delivered in clinical settings, some can be delivered within communities, worksites, schools, residential treatment centers, or homes.

VADM Regina M. Benjamin, Surgeon General

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Public Health Reports / November–December 2011 / Volume 126

Clinical preventive services can be supported and rein- forced by community-based prevention, policies, and programs. Community programs can also play a role in promoting the use of clinical preventive services and assisting patients in overcoming barriers to preventive services (e.g., transportation, child care, and patient navigation issues).

Empowered people We must empower people to make responsible, informed, and healthy choices. By providing people with the tools and information to make healthy deci- sions, we can lead our country to become an indepen- dent and reliable manager of its own health. People want to be healthy; we need to provide them with easy and affordable options to maintain their health. These options include access to healthy food, places to exercise, appropriate nutrition information, and positive social interactions.

Elimination of health disparities Finally, we must eliminate the health disparities that exist in our nation. No population should shoulder a disproportionate burden of illness and disease. Unfortunately, many health concerns, including heart disease, asthma, obesity, and HIV/AIDS, dis- proportionately affect certain populations of people. Without education and employment, people are often ill-equipped to make healthy choices. Education can increase health knowledge and allow people to make better-informed choices for themselves and their families. Employment can provide access to health coverage and prevention care, allow people to live in healthy and safe neighborhoods and housing, and enable families to afford healthy food and other basic goods. Programs and policies to reduce high school dropout rates make advanced education more attain- able, promote job growth, and, ultimately, have a large impact on people’s ability to make healthy choices.1

With a strategic focus on the communities at greatest risk, and those that require the greatest support, we can work toward providing all Americans with a chance to live a healthy and fi t life.

Priority areas In addition to these strategic directions, the National Prevention Strategy has identifi ed seven priority areas that require immediate focus to improve the health of the American people, particularly those who are disproportionately affected by disease and injury:1

• Tobacco-free living

• Preventing drug abuse and excessive alcohol use

• Healthy eating

• Active living

• Injury- and violence-free living

• Reproductive and sexual health

• Mental and emotional well-being

In focusing on these priorities, the National Prevention Strategy seeks to address the underlying causes—e.g., tobacco use, misuse of alcohol and other substances, obesity, and community stressors such as discrimination and violence—of chronic conditions (e.g., heart disease and diabetes) and unintentional injuries.

A NATION’S EFFORT

While the core of this prevention movement will come from a trained and knowledgeable prevention work- force that is attuned to community and population conditions and disparities, and equipped to serve the needs of an aging nation, many other stakeholders will need to help ensure the success of this National Prevention Strategy.

Public and private sectors alike can improve the coordination and collaboration of prevention-driven services and programs that address key health needs. For instance, businesses can support workplace well- ness, health providers can enhance health-care quality and delivery, and educators can incorporate prevention competencies into relevant curricula.

On the individual level, we can all make changes to incorporate prevention activities into our day-to-day lifestyle. Using alternative transportation such as bik- ing or walking, purchasing energy-effi cient household products and recycling, and better managing personal health through technology such as text reminders and phone applications are all simple ways to make informed, responsible, and healthy choices.

This strategy for disease prevention must become America’s plan. All of us, together, must take ownership of our health, and we must collaborate and cooperate to achieve a healthy and fi t America.

Regina M. Benjamin, MD, MBA VADM, U.S. Public Health Service

Surgeon General

The author thanks Arndreya D. Price, Neha A. Deshpande, and Jo Ellen Russ for their contributions to this article.

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Public Health Reports / November–December 2011 / Volume 126

REFERENCES 1. National Prevention Council (US). National Prevention Strategy:

America’s plan for better health and wellness. Washington: Depart- ment of Health and Human Services, Office of the Surgeon General (US); 2011. Also available from: URL: http://www.healthcare.gov/ center/councils/nphpphc/strategy/report.pdf [cited 2011 Jul 14].

2. Patient Protection and Affordable Care Act. Pub. L. No. 111-148 (2010).

3. Centers for Medicare and Medicaid Services (US), Office of the Actuary, National Health Statistics Group. National health expen- ditures 2009 highlights [cited 2011 Aug 22]. Available from: URL: http://www.cms.gov/NationalHealthExpendData/downloads/ highlights.pdf

4. Maciosek MV, Coffield AB, Flottemesch TJ, Edwards NM, Solberg LI. Greater use of preventive services in U.S. health care could save lives at little or no cost. Health Aff (Millwood) 2010;29:1656-60.