Preventable diseases=health care costs

Public health in the U.S.? “It would be difficult to spend this much money and do worse,” says Thomas R. Frieden, Director of the Centers for Disease Control and Prevention. It is the ‘prevention’ issue on which we get an F: tobacco, obesity, teen pregnancy and motor vehicle accidents, all preventable, are where our health care dollars go, Frieden says; and if we would shape up, literally and figuratively, there would be savings in the millions of lives and billions of dollars.

Frieden, who also serves as Administrator of the Agency for Toxic Substances and Disease Registry, is in a position to understand all this. A physician with training in internal medicine, infectious diseases, public health and epidemiology, he has spent the past several decades combating disease and advocating for preventive measures across the U.S. and around the world. He took over as head of CDC in June, 2009.

Speaking to an audience of health professionals and community members at San Francisco’s Commonwealth Club recently, Frieden launched his remarks with a story of treating one patient, a few years ago, who had multi-drug resistant tuberculosis (TB is on the rise these days.) Cost of treatment? Over $100,000. Cost of prevention, had this one man been vaccinated? $10.

High on the list of largely preventable diseases, Frieden said, is cardiovascular disease. Simple measures like quitting smoking, cutting down on (or eliminating) trans fats and losing weight would lead to huge reductions in expenditures on treatment of cardiovascular disease, not to mention longer, healthier lives. He also cited the $200 billion cost of tobacco-related disease, which currently claims some 1200 lives per day.

Other preventable health care costs come from teen pregnancy and motor vehicle accidents, Frieden said, citing the dollars that are saved when these don’t happen. But he came down hardest on obesity. “It is epidemic in the U.S.,” he said. “And in the next 30 years obesity is expected to double in adults and triple among children.”

One audience question (OK, it was submitted by this writer/agitator) went unanswered in the Q&A session following the talk: How can the exorbitant costs invested in often-futile end-of-life treatment be reduced? But that question may have been buried in the substantial pile of other questions posed in relation to the above, and other issues such as:

Can CDC spread some money around to states and local governments for health care? “In a word, no.” And what about the catastrophic Deepwater Horizon oil spill? Its effects will be with us for a long time, Frieden said, but CDC’s primary concern right now is with health and safety of workers and others on the scene. CDC is involved with a number of other agencies addressing the human and environmental impacts of the disaster.

The event was introduced by California HealthCare Foundation Director of the Chronic Disease Care Program Sophia Chang, and moderated by University of California San Francisco Chancellor Emeritus and Global Health Institute Director Haile Debas.

On the good news side — which was a slim side of the room, no pun intended — Frieden cited progress in efforts to promote biking and walking as an alternative to the automobile (currently costing $4 million in emergency room visits and $200 billion overall annual costs; “$12 billion could be saved by seat belts”) and in HIV prevention (treatment for one person: $400,000; cost of a condom, five cents.)

This reporter stood briefly at the back of the near-capacity crowd before the talk started and counted 24 audience members who would qualify as obese. It’s easy to feel righteous when you’ve never had a major weight problem and you got to the event on foot and on Muni bus. It’s hard to feel unsympathetic when you can’t seem to lose those 3 or 4 pounds you could really do without, when you smell the french fries while passing every fast food joint on Market Street and you know how many people don’t have access to good public transportation.

Public health is, indeed a public problem. Dr. Frieden has his work cut out for him.