The prevalence of chronic disease in the U.S. exacts a significant human and financial toll. According to the Centers for Disease Control and Prevention (CDC), roughly six in ten American adults suffer from at least one chronic disease like cancer or heart disease; 40 percent have two or more. These conditions are the leading causes of death and disability and — once lost economic productivity is factored in — cost trillions of dollars annually.
The practice of preventive healthcare, including measures like vaccinations and cancer screenings, can dramatically improve individual and community health and greatly reduce healthcare costs. A 2019 study by the Milken Institute found that by improving healthcare, with an increased focus on preventive health services, the U.S. could potentially avoid 40 million cases of chronic disease and reduce its economic impact by $1 trillion by 2023.
Despite its many benefits, however, the use of preventive healthcare services in America is still relatively low. According to a 2018 study published by Health Affairs, only 8 percent of adults 35 and older received all recommended, high-priority clinical preventive services and almost 5 percent received none. This issue has been exacerbated by the COVID-19 pandemic, which saw many people forego preventive health services due to concerns over social distancing.
To better understand preventive medicine, it’s critical to examine exactly what it is and why it’s so important, as well as explore the different forms it can take.
What Is Preventive Healthcare?
Preventive healthcare seeks to promote the health of individuals and communities through the detection and/or prevention of serious diseases and other medical problems. Services like annual checkups, mammograms, colonoscopies, and vaccinations all fall under the umbrella of preventive care.
Preventive healthcare is vital to ensuring the health of entire populations, from individuals impacted by chronic conditions to communities at risk of contracting and spreading emerging illnesses, such as COVID-19. Examples of preventive health practices can be found as far back as the Middle Ages, with the implementation of various sanitary measures designed to prevent disease spread and the quarantining of plague victims.
Preventive healthcare can be broken down into four different levels, based on what sort of prevention is needed. They are as follows:
1. Primordial Prevention
Primordial preventive care involves reducing risk factors and promoting health among an entire population by focusing on improvements in social and environmental conditions, often through the passage of laws and policies. Creating more recreational spaces and improving access to safe sidewalks in urban areas to promote physical activity — which can help reduce the rates of obesity and diabetes — are examples of primordial prevention.
2. Primary Prevention
Primary preventive care focuses on promoting the health of communities and individuals by preventing disease from ever occurring, either by limiting exposure or increasing immunity. Vaccinations are a form of primary prevention.
3. Secondary Prevention
Secondary prevention emphasizes early detection. These measures target outwardly healthy individuals who may be at risk for disease or are in the very early, asymptomatic stages of disease. Pap smears and colonoscopies are examples of secondary prevention.
4. Tertiary Prevention
In tertiary prevention, the focus is on reducing the severity of a disease in people who are already experiencing its effects. Rehabilitation programs are a common form of tertiary prevention.
Subspecialties of Preventive Healthcare
Within the field of preventive healthcare are a number of commonly recognized subspecialty areas, each one with a different focus:
- Public health and general preventive medicine focuses on health promotion and disease prevention among both individuals and communities in the general population.
- Occupational medicine seeks to improve the mental and physical health of workers by improving the physical, structural and social conditions in the workplace.
- Aerospace medicine focuses on the health and safety of crew members and passengers on air and space vehicles, which can pose unique health hazards.
The Importance of Preventive Healthcare
Preventive healthcare has many benefits, for both individuals and communities. First and foremost, regular use of preventive services can lead to improved health outcomes, preventing the onset or minimizing the severity of disease, as well as curbing its spread. However, the importance of preventive healthcare is about more than just health and wellness.
Chronic conditions like heart disease, cancer and respiratory diseases are among the nation’s greatest health risks. According to the CDC, those three conditions alone account for roughly half of all U.S. deaths — for both men and women across every age group — annually. These diseases can drastically reduce the quality of life for individuals and their families, negatively impacting their relationships and finances and potentially causing adverse effects on their mental health.
Preventive health services can help patients avoid disease altogether (primary prevention), detect and treat it at an early stage (secondary prevention) or manage its symptoms and/or stop its progression (tertiary prevention). These measures, along with lifestyle changes, can reduce the incidence of chronic disease and the disability and death that comes with it.
Aside from the benefits for individuals, preventive healthcare can also improve the health and overall quality of life for entire communities. Vaccines limit the spread of illness among a population, while policies and programs promoting healthy lifestyles can have broad impacts on the overall health of a community.
Taking a population health approach to preventive care can also help reach underserved communities and address long-standing inequities in healthcare-related to racial, ethnic or socioeconomic factors.
Preventive care can also help reduce healthcare costs. According to the CDC, approximately 90 percent of the more than $3 trillion the U.S. spends each year on healthcare stems from people with chronic diseases.
People who lack access to preventive care are more likely to visit the hospital than their physician. The cost of hospital care is often very expensive, however, making up roughly one-third of all healthcare costs in America, according to an analysis by the Peterson Center on Healthcare and the Kaiser Family Foundation. Hospitals have to recoup these costs, even if patients can’t afford to pay them, so they often get shifted to health insurance premiums and Medicaid, driving up the cost of healthcare for everyone.
Much of the cost associated with chronic conditions could be minimized with preventive health services, either by detecting the conditions before they require more intensive (and expensive) care or by helping patients avoid them altogether.
Preventive Healthcare Examples
Preventive healthcare takes many forms. Some types are meant to prevent disease altogether, while others detect disease in its earliest stages. The goal of all preventive healthcare is to protect and promote the health of both individuals and communities.
Examples of Preventive Healthcare for Individuals
Some common preventive healthcare examples that apply to individuals include the following:
- Annual checkup. Sometimes referred to as a physical, this is a routine examination by a primary care physician to check all areas of a patient’s health, physical and emotional. Checkups can sometimes help doctors identify health problems early before they become more serious.
- Mammogram. Typically performed once per year after a woman reaches the age of 40, mammograms scan breast tissue to check for signs of cancer or other abnormalities.
- Colonoscopy. Like a mammogram, a colonoscopy is a routine screening for older adults — usually once every 10 years after the age of 50 — to check for colon cancer.
- Vaccinations. Among a host of available vaccinations, some are administered during childhood (e.g., measles vaccines) and others are given periodically throughout a person’s life (e.g., tetanus and flu vaccines). Vaccinations protect an individual from infection and can help prevent the spread of infection in a community.
One of the perks of preventive care, besides the obvious health benefits, is that many of these services are provided at no cost as part of a health insurance plan. Being proactive about health is ultimately less expensive — for both patients and providers.
Examples of Preventive Healthcare for Communities
Efforts geared toward health promotion and health literacy are hugely valuable in a community context. These measures can reduce behavioral risk factors like tobacco use, substance abuse, and obesity and physical inactivity and improve mental and sexual health. Some examples of community preventive health measures include the following:
- Public awareness campaigns
- Dietary and nutritional interventions
- Adoption of programs, policies and practices to promote healthy lifestyles
Community health centers are another excellent resource for providing preventive healthcare to a population. They provide access to healthcare for underserved populations and help improve health on a community-wide basis. According to the Health Resources and Services Administration (HRSA), federally funded community health centers served nearly 30 million people in 2019, up from just 9.6 million in 2000.
These centers provide services ranging from basic preventive medical and dental care to more advanced treatments for chronic conditions. Despite caring for a population that is generally sicker and poorer than those in other healthcare settings, community health centers are often successful in producing positive patient outcomes, particularly when it comes to preventive services, according to the HRSA.
- Of health center patients with diabetes, 68 percent managed to control their blood sugar levels, compared to the national average of 59 percent.
- Of health center patients with hypertension, 65 percent were able to control their blood pressure, exceeding the national average by 6 percent.
Community health centers are instrumental in addressing public health concerns, such as the opioid crisis and the HIV epidemic. According to the HRSA, in 2019 health centers provided treatment to nearly 143,000 patients for substance abuse and treated one in five patients diagnosed with HIV. The centers have also been a critical resource during the COVID-19 pandemic, providing testing and care for millions of people affected by the crisis.
Preventive Healthcare Services
In addition to cancer screenings and vaccinations, many other types of preventive healthcare services are available, ranging from those that detect or prevent disease to services that promote healthy lifestyles. They include the following:
- Blood pressure, diabetes, and cholesterol tests
- Screening for various illnesses
- Counseling to help with behavioral health risks, such as tobacco use, weight loss, and substance abuse
- Assistance for new or expectant mothers
These services help to ensure individual health but are also vital to promoting the overall health and well-being of the community. However, issues related to access and affordability prevent millions of Americans from receiving preventive health services.
Use of Preventive Health Services
Despite the obvious benefits, the use of preventive healthcare services remains relatively low among Americans as illustrated by results from the 2018 Health Affairs study.
A variety of reasons have been cited for this, the most common being either a lack of access to care or a lack of health insurance. Disparities related to race, ethnicity, age, and a host of other factors play a part in the issue of access to care, as does geography. Millions of Americans in rural areas don’t have access to preventive services due to workforce shortages.
A report published by the CDC posited another reason for the low rate of preventive care utilization: providers are financially incentivized to focus medical care on treatment rather than on prevention. Putting a greater emphasis on prevention — and creating value-based payment models to incentivize providers — could have a positive impact on the use of preventive healthcare.
The Impact of COVID-19 on Preventive Health Services
Due in part to concerns over social distancing, the number of people receiving preventive services dropped off significantly during the COVID-19 pandemic, according to an analysis by the Health Care Cost Institute.
- Childhood immunizations dropped by 60 percent in April 2020 compared to 2019.
- Mammograms and Pap smears were down by 80 percent during the same period, though they rebounded in the late summer and fall.
- Colonoscopies plummeted by nearly 90 percent at the start of the pandemic and were down almost 25 percent overall in 2020 compared to 2019.
In response to the complications presented by the COVID-19 pandemic, The New England Journal of Medicine recently released a report that advocated for a greater population health approach to preventive care. It suggested healthcare providers shift their focus from in-person annual exams to programs that provide easier access and place greater emphasis on community health, such as registries that identify what preventive services a patient needs, self-scheduling of preventive services in more easily accessible settings, and community-based strategies to overcome health inequities in underserved populations.
Careers in Preventive Healthcare
A number of career paths are available to those with an interest in preventive healthcare. These positions, particularly those at the administrative and leadership level, are critical to promoting the health of individuals and communities.
Jobs for those seeking careers in preventive healthcare are expected to grow significantly over the coming decade as the country’s population ages.
Health administrators — sometimes called medical and health services managers — play a critical role in managing healthcare services at hospitals, health systems, and clinics. They develop strategy and oversee medical staff, and are ultimately responsible for improving healthcare delivery for entire groups of patients.
According to the U.S. Bureau of Labor Statistics (BLS), the employment of medical and health services managers is projected to grow by 32 percent from 2019 to 2029, creating an additional 133,200 jobs. The median salary for those in the field was $104,280 as of May 2020.
Medical and health services managers typically possess a graduate degree in a field such as health administration or health management. They usually have several years of experience in either a clinical or administrative position before moving into a manager/administrator role. This experience allows them to hone the necessary leadership, communication, and technical skills they’ll need to excel in a health administrator role.
Social and Community Service Manager
Social and community service managers oversee programs and organizations that support public health. They work for a variety of organizations assisting different groups of people, including children, homeless individuals and the elderly, as well as those struggling with substance abuse or mental health issues.
The job market for social and community service managers is projected to grow 17 percent from 2019 to 2029, adding nearly 30,000 more jobs, according to the BLS. The median salary for social and community service managers was $69,600 as of May 2020.
Most social and community service manager positions require at least a bachelor’s degree in social work, public health, business administration or a related field. Some positions also require a master’s degree. Experience as a social worker, as a substance abuse counselor or in a similar position is essential to becoming a social and community service manager.
Prevention Is the Best Medicine
Preventive healthcare is crucial to improving the health of individuals and the communities in which they live. In addition to their health benefits, preventive services could potentially reduce the cost of healthcare in America significantly. Despite this, the use of preventive health services is relatively low, due largely to issues related to access and affordability. Health administrators and other preventive healthcare leaders are needed to overcome these hurdles and ensure a healthier nation.
Explore Duquesne University’s online Master of Health Administration program and its Population Health concentration to better understand how preventive healthcare can benefit individuals and communities.
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The Balance, “Why Preventive Care Lowers Health Care Costs”
Centers for Disease Control and Prevention, Chronic Diseases in America
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Centers for Disease Control and Prevention, Leading Causes of Death — Males
Centers for Disease Control and Prevention, Leading Causes of Death — Females
Cigna, What Is Preventive Care?
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Health Care Cost Institute, “The Impact of COVID-19 on the Use of Preventive Health Care”
Health Resources and Services Administration, Health Center Program: Impact and Growth
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