Disease Prevention (Definition)

As a health insurer or employer who offers healthcare to your employees, you probably know how healthcare works in this country. Many people avoid the doctor until they get sick. When they do go, they may use emergency room services or need costly prescription medications or treatments. In short, the sickest patients use the most healthcare resources, such as providers’ time, facilities, and dollars.

This pattern may seem unavoidable since it is so ingrained in our culture, but there are other ways to approach healthcare. One approach is a preventative approach that can help more people maintain better health. Improving quality of life by preventing disease is not just ethically the right thing to do. It makes economic sense, too.

Disease prevention is not yet the prevailing culture, but it is increasingly being recognized as being cost-effective and worthwhile. In addition, health technology, such as digital coaching, is available that can increase access to preventive care.

Importance of Disease Prevention

Why is chronic disease prevention important? There are two main reasons.

1. Treatment is expensive.
2. These diseases are largely preventable.
3. Prevention is feasible and simple.
4.  

Treatment is expensive. The overwhelming medical and indirect costs of chronic diseases should provide ample motivation to prevent them. Medical expenditures for chronic and mental health account for 90% of healthcare spending in the United States.[1] The annual medical costs and costs of lost productivity associated with diabetes and obesity are $245 billion and $147 billion, respectively. The medical costs of hypertension add another $109.1 billion[2,3 ], before considering indirect costs such as lost productivity.

On their own, the outlandish costs of these conditions are not enough to spur action if there is no way to prevent them, but thankfully, they are preventable. 

These diseases are largely preventable. A harmful misconception about diseases is that they are inevitable, and the belief that the only thing that can be done with diseases is treat them has led to harmful and unnecessary consequences, including poor health outcomes and skyrocketing costs from medical expenses and lost productivity.

Dig a bit, though, and it becomes apparent that most prevalent diseases and their consequences are preventable. Losing excess weight, achieving physical activity goals and choosing a more nutrient-dense diet can dramatically lower risk of chronic diseases including type 2 diabetes, certain cancers, and cardiovascular disease. In fact, “90 percent of type 2 diabetes, 80 percent of coronary artery disease, and 70 percent of stroke” are considered attributable to poor lifestyle choices[4]. Regardless of genetic risk factors, addressing modifiable risk factors can improve outcomes.

Prevention is feasible and simple. Most chronic diseases could be prevented or delayed with simple and inexpensive solutions. These strategies do not involve high-tech, experimental genetic modification, expensive or risky surgery, or costly medications with short-term side effects and long-term risks. They do not even require extensive physician involvement – and that’s important, given that nearly 2 out of every 5 visits to the doctor are for chronic conditions[5]. 

Instead, the proven effective strategy to prevent the most common and costly chronic diseases is far simpler, less expensive, and without side effects. It involves individuals making healthy lifestyle choices on a daily basis to maintain health and reduce health risks. These behaviors require healthy choices and are largely considered the responsibility of the individual, although support has been found to be instrumental in promoting healthy choices. While in-person clinical support systems can increase the likelihood of patients achieving their goals, digital alternatives, such as Lark health coaches, can be more accessible and less expensive.

Preventing and mitigating the impact of chronic diseases can happen at any time in any population, from apparently healthy to long-ago diagnosed. The principles of primary, secondary, and tertiary prevention can help illustrate this.

Primary Prevention

Primary prevention refers to preventing diseases before they occur. Targeted individuals might have only few or minor risk factors. These are some examples of primary prevention. 

• Healthy individuals using Lark Wellness to establish healthy, disease-preventing habits such as getting regular physical activity, eating more vegetables, and getting adequate sleep.
• Educational campaigns or materials targeted to the general healthy population, such as anti-tobacco ads targeted to young people who do not smoke, or nutrition labels with calorie content available to people regardless of weight status.
• Establishing a culture of health in the workplace, such as distributing health newsletters and encouraging group walks during lunch hours. 

Secondary Prevention

Secondary prevention aims to minimize the effects of diseases in their earliest stages and to prevent their progression. It can include screening in order to enable early referrals and treatment. These are some examples of secondary prevention.

• Checking height and weight to calculate body mass index (BMI) to determine if someone is overweight or obese, and if so, referring him to a weight management program.
• Measuring blood pressure at each doctor’s visit to detect and then treat high blood pressure as soon as possible.
• People with prediabetes or other risk factors for diabetes using Lark Diabetes Prevention Program (DPP) to lower diabetes risk through weight loss, physical activity, healthy eating, and stress management.
• Diabetes patients attending recommended specialist appointments to check for changes in vision, reduced kidney function, and foot wounds before they become untreatable.

Tertiary Prevention

Tertiary prevention refers to managing established diseases to slow progression and reduce complications. These are some examples of tertiary prevention.

• Patients with diabetes using Lark Diabetes Pro to control blood sugar and lower risk of complications through weight management, physical activity, blood glucose monitoring, and medication adherence.
• Patients with hypertension lowering stroke and cardiovascular by adhering to the Dietary Approaches to Stop Hypertension (DASH) diet with the help of Lark Hypertension Pro.
• Obese individuals following a weight loss program.

Chronic Disease Prevention and Management Strategies

Chronic disease prevention and management strategies can be multi-faceted and targeted towards all three levels of prevention. Realistic strategies must consider cost and cost-effectiveness, reach, and effectiveness. These are some approaches to chronic disease prevention that can have widespread impact.

• Ad campaigns, such as “Five a Day” to promote fruit and vegetable consumption or “Got Milk?”
• Wellness fairs with information and free screenings, such as blood pressure measurement and diabetes risk questionnaires.
• Policies that promote healthy choices, such as prohibiting smoking in and near buildings, or subsidizing fruits and vegetables to make them more affordable.
• Cultures of wellness in workplaces to make healthy choices easier, such as having vending machines with fresh fruit and encouraging walk breaks for employees.
• Providing reimbursement for prevention programs, such as Medicare coverage for CDC-recognized Diabetes Prevention Programs.
• Promotion of healthy behaviors by individuals and families, such as using food logging apps for weight loss.

Primary care and specialty doctors, nurses, and other healthcare providers are indispensable for chronic disease management, but patients shoulder the brunt of the responsibility for their own wellness. Their decisions about food choices, physical activity, and, if warranted, medication adherence and self-monitoring of blood glucose or blood pressure, have a great influence on chronic disease development and risk. 

These behaviors are tough to implement, and many people can do better with support from nurses, nutritionists, and other healthcare professionals. Live support from these types of professionals is in short supply. Many people have minimal access, and even those with excellent support systems are likely to be limited in the amount of contact they get and the hours the support is available.

Digital apps, such as Lark health coach, can address these shortcomings with unlimited, anytime access for users. The coaching programs are powered by artificial intelligence and backed by nutrition, exercise, sleep, and other specialists to allow delivery of personalized, evidence-backed behavior change programs to all users. The system allows for instant and infinite scalability at cost.

Benefits of fully automated health coaches can include the following.

• High engagement rates and health outcomes comparable or superior to in-person interventions.
• Reduced shortfalls in healthcare since each patient can have a 24/7 personal coach.
• Fewer disparities, due to distance, socioeconomic status, or race/ethnicity, in healthcare access due to off-site, digital access.
• More economical use of doctors and nurses, with not contacting them if unnecessary but contacting them if needed, which can reduce the time they spend and reduce emergency room visits. 

This is an exciting time in healthcare. Chronic diseases are dominating medical care, healthcare costs, and productivity in the workplace, but the opportunity is there to make a difference. Primary, secondary, and tertiary prevention allow for health and economic improvements at any point on the wellness-disease spectrum, and a single intervention, Lark, offers coaching for healthy behavior changes for weight loss, wellness, diabetes prevention management, and hypertension. Employers and healthcare providers can get full support when implementing their chronic disease prevention programs. Lark is now Fully CDC Recognized.

References

1.  National Center for Chronic Disease Prevention and Health Promotion. Health and Economic Costs of Chronic Diseases. https://www.cdc.gov/chronicdisease/about/costs/index.htm. Reviewed February 2, 2017. Accessed February 4, 2019.
2.  Zhang D, Wang G, Zhang P, Fang J, Ayala C. Medical Expenditures Associated With Hypertension in the U.S., 2000-2013. Am J Prev Med. 2017;53(6S2):S164-S171. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5823517/
3.  Centers for Disease Control and Prevention. High Blood Pressure Costs. https://www.cdc.gov/bloodpressure/facts.htm Reviewed November 30, 2016.
4. Walter C. Willett, Jeffrey P. Koplan, Rachel Nugent, Courtenay Dusenbury, Pekka Puska, and Thomas A. Gaziano. Chapter 44: Prevention of Chronic Disease by Means of Diet and Lifestyle Changes. Disease Control Priorities in Developing Countries. 2nd edition. Jamison DT, Breman JG, Measham AR, et al., editors. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; New York: Oxford University Press; 2006.
5.  Ashman JJ, Rui P, Okeyode T. Characteristics of office-based physician visits, 2015. NCHS Data Brief, no 310. Hyattsville, MD: National Center for Health Statistics. 2018.