As an emergency physician, I know the importance of urgent treatment. A patient coming to the emergency room with crushing chest pain needs to be treated immediately for his heart attack. He should receive high-quality health care — stents, bypass surgery and medications for high blood pressure and diabetes — without worrying about it bankrupting his family.
But care can’t stop there, nor should it have started there. We need to figure out what could have been done to prevent his heart attack. Maybe he didn’t have a primary care doctor and never got a checkup. Maybe he couldn’t afford to take time off from work and had trouble paying for prescriptions. Maybe he lived in a food desert, without access to healthy foods.
Prevention is an integral part of good medical care. It’s also sound health policy: Chronic diseases that are avoidable through preventive care account for 75 percent of America’s health-care spending and decrease economic output by an estimated $260 billion a year.
Yet prevention is often forgotten, or even deliberately dismissed.
Wednesday, the candidates spoke passionately about how they will protect and expand access to safe, legal abortion. If abortion care is regarded as the medical care that it is, then prevention needs to be part of the policy discussion too. A goal of cardiac care is to prevent heart attacks by managing blood pressure, diabetes and other chronic conditions. Reproductive care should similarly aim to prevent unintended pregnancies and the need for abortions through sex education and birth control.
Unfortunately, abortion-rights advocates have condemned the prevention-first language as stigmatizing to women who have abortions. They argue that the focus should be on removing restrictions and improving access. But access and prevention are not in conflict with each other. The patient with a heart attack should receive the treatment he needs, but that shouldn’t stop his providers from working with him to prevent the next one. And it certainly shouldn’t stop policymakers from enacting policies that reduce chronic diseases and promote health.
To be clear, emphasizing prevention does not mean that treatment should be restricted. When I served as the Baltimore city health commissioner, I implemented a three-pronged strategy for addressing addiction in which treatment and prevention work in concert. First, we made naloxone, the opioid antidote, available to all so that people who are overdosing can receive immediate lifesaving treatment. Second, we increased access to long-term medical treatment as part of the cultural shift for addiction to be regarded as a public health issue, not a criminal justice one. Third, we worked to reduce opioid overprescribing and mitigate the social factors that fuel addiction, because the ultimate goal must be to prevent the next generation from harm.
A strategy that leads with prevention does not mean that the condition itself is stigmatized. Not all cases of overdose, heart attack or abortion can be prevented, and there should be no blame placed on a patient who needs medical care.
But we must also acknowledge that medical procedures are costly and always have some associated risk. Most people would want to avoid them and resort to them only when necessary. Making treatment available, accessible and affordable is a social good, and so is prioritizing prevention to reduce the need for that treatment.
Next time, I’d like to hear candidates explain their plan to lower health-care costs by discussing how improving food access, reducing air pollutants and incentivizing healthy choices will keep people out of hospitals. I’d like to hear them follow their treatise on maternal mortality with how they will ensure women are healthy before, during and after their pregnancies. I’d like to hear the word “prevention” stated proudly as a goal for all aspects of medical care.
As the saying goes, prevention is the best medicine. In these polarized times, prevention may also be a way for us to reach much-needed common ground and make progress on what should be in everyone’s interest: to improve health and well-being for all Americans.