"An Ounce of Prevention is Worth a Pound of Cure”: but how do we change our health systems?

Overview The 100-year life is coming many HKS students will end up living a century. That’s a huge opportunity. But without radical action, too many people will spend their extra years with chronic disease diabetes, heart problems, dementia. There is a growing gap between rich and poor in terms of life expectancy and healthy life expectancy in Western countries (the poorest can expect to spend 9 more years in poor health than the richest). Even as smoking rates fall, obesity, type-2 diabetes and hypertension are rising.

Tackling those chronic diseases will mean changing our health care systems; reaching across the medical silos and building networks which can interact with patients on a long-term basis; very different to the post-war systems which patched us up and sent us on our way. And it will make effective prevention of disease far more important. Yet Western healthcare systems spend far more on treating disease than preventing it – the ratio is around 101 in the US and UK, the Netherlands and Norway, and even lower in Australia. Modern health services were set up to treat disease, not to preserve health – and that’s how they book the financial gains.

Public health is the Cinderella of government policy, the bit which gets cut when funding is tight. It’s easy to quantify the costs of treating the sick, harder to judge the impact of public health interventions to keep people healthy, whose pay-offs are often long term and hard to quantify. Yet some kinds of “social prescribing” are already showing results. At Geisinger’s Fresh Food Farmacy, doctors are prescribing food as medicine. At MIRA Rehab, therapists are using gaming software to help patients improve strength and balance. We know that genomics and AI will improve our ability to predict who is most at risk. Moreover research suggests that doctors can be powerful advocates for simple lifestyle changes – if they want to be.

Senior Fellow Baroness Camilla Cavendish, former senior advisor to UK Prime Minister Cameron and author of the UK government’s soda tax, will be joined by Thomas J. Croce, Jr, Vice President, Global Advocacy Relations, Amgen Inc.

Thomas Croce is a former practicing pharmacist, and now a senior executive at Amgen, the biopharmaceutical company - one of Fast Company’s 2019 “most innovative companies in biotech”. He will argue that health systems need to shift from “break and fix” to “predict and prevent”, drawing on his 15 years’ experience of practice in hospitals and the community. How can we do more, for example, to tackle heart disease earlier? Should we consider providing technology like wearables to employees to track risk factors? Are incentives aligned for a “predict and prevent” system?

Together with Laura Heath, primary care physician and MPH student at the Harvard Graduate School of Public Health, the group will examine evidence for what kinds of behavioural medicine are successfully improving health. We will analyse the barriers to adopting such schemes, and ask whose responsibility is prevention? What can different parts of the medical community, and government do, and what must we as individuals do ourselves? We will discuss the clinical and financial barriers to prevention, and conclude by considering what public policy changes could be made to improve health for all.