What is Preventive Heath Care?

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Paul Krugman writes that GOP staffers recently jeered at the part of a Kaiser Permanente presentation that discussed the importance of preventive health care. (It's a "slush fund," apparently.) Claiming that there is no such thing as preventive health care is the medical equivalent of saying that the world is flat, yet I've seen this showing up more and more in the comments that I monitor. There are even cherry-picked references to a CBO study. (Funny how conservatives like the CBO just fine when they can distort it to in their own interests.)

The thing is, Americans have relatively ineffective preventive health because we practice it in the context of our commitment to heroic medicine. There's much more to the concept than a yearly physical and PSA (which may not do that much good, anyway). We don't really practice what is known as population health, which includes outcomes, determinants, interventions, and policies that impact the health of a group. A group can be as small as the total number of patients in a given practice and as large as the entire population of a country, and be based on condition, locale, demographics, or some combination of the three.

At the end of the first quarter of school, my team made a presentation based on steps that could be taken to reduce the number of pediatric asthma admissions to a rural emergency department in an area with a heavy migrant worker population. We set a goal (50% reduction, based on research) and designed a program based on ED clinical staff training, patient education, check-in and check-out procedures (wherein, for example, no one left without what's called an Asthma Action Plan), home mitigation strategies, and primary care followup. We minimized other possibilities because of budget limitations and likely behavioral restrictions on the families. This is the idea behind preventive care based on population, although it doesn't address public policies that might improve outcomes even further (such as improving air quality eroded by a high concentration of pesticides).

So, if someone tells you that preventive health care doesn't work, the chances are that they don't know what it is and that they're unaware that we really don't practice it here.