By Ed Martinez – June 6, 2002
Our community shares a common belief that San Diego’s health care system is in a state of crisis that threatens to lock out thousands of vulnerable people from basic medical services in times of need. Over the past several months, the Union-Tribune has published several articles that have highlighted what many believe to be the root causes of San Diego’s health care crisis i.e., exploding insurance premiums, costly hospital services, increasing costs for new technology and skyrocketing co-payments for life-saving medications. These problems prove particularly severe for San Diego’s approximately 600,000 uninsureds.
Historically, communities (and consumers) played a passive role in how healthcare providers priced and delivered their services since the consumer felt far less impacted from the cost of health care than they do now. Today, this situation imperils the well being of all San Diegans. The dramatically escalating cost of healthcare is both disturbing and prohibitive. Our community must act.
San Diegans must take a proactive approach to health care reform by commissioning our county’s Health and Human Services agency to take a leadership role in developing a countywide public health initiative. This initiative would focus on (1) maintaining and enhancing the overall health of the community and (2) emphasizing preventive services, screening programs and health literacy activities that empower people to self-manage their personal health conditions.
This public health approach to safeguarding the health and safety of our community has been found to be highly cost-effective by the federal Centers for Disease Control and Prevention (CDC). Consider the following:
- Children with life-long exposure to optimally fluoridated water have at least 18% fewer dental caries than children without such exposure. The average cost of fluoridating drinking water for one person’s lifetime is $38.25. Every $1 spent on water fluoridation could save as much as $80 in treatment costs for dental caries in children.
- Low birth-weight is a principal cause of infant mortality and a leading cause of childhood illness. Early and adequate prenatal care and proper nutrition during pregnancy can lower the risk of having a low birth-weight infant. If all U.S. women received adequate prenatal care, the estimated savings would be $14,755 per low birth-weight birth prevented.
- Reducing fat intake 1% to 3% would reduce the overall incidence of coronary heart disease by 32,000 to 92,700 cases, saving $4.1 billion to $12.7 billion in medical costs and productivity losses over 10 years.
- A review of studies conducted in the United States, Europe, and Canada reported that mortality attributed to cervical cancer has been reduced by 20% to 60% since the implementation of cervical cancer screening programs. Performing Pap tests every three years reduces invasive cervical cancer by 91.2%.
- The cost of treating a patient with colon cancer varies from $20,000 to $30,000 depending on the stage of the disease. Studies have documented a 31% to 57% reduction in the risk for colon cancer among persons who receive fecal occult blood testing.
Public Health Starts in the Community
Other counties have found that the following public health initiatives, when based in neighborhood settings, have positively impacted the health status of residents:
Health Literacy – In this age of information technology, the public is demanding access to the most current and accurate data available. The consumer of health care services deserves easy access to the latest medical science information relating to disease prevention/health promotion innovations. This information supports the public’s interest in health literacy activities that promote positive lifestyles and reduce risk behaviors.
Accessible Health Screenings – Simple and effective tests are available that provide early detection of heart disease, diabetes, and cancers of the breast, cervix, colon, as well as other serious conditions. A community-wide disease prevention initiative requires that comprehensive screening services be available to all age groups on a periodic basis, particularly high-risk populations such as the very young and frail elderly.
Childhood Immunizations – According to the CDC, every dollar spent on immunization against measles, mumps and rubella results in a $13 dollar savings in future medical expenses. A key strategy of any disease prevention initiative is to increase immunization levels in all children and adolescents. Experience in San Diego has shown that community clinics and other non-profit service organizations effectively serve San Diego’s uninsured population. These health centers and clinics offer multiple delivery sites for dispensing immunization services.
Teenage Counseling Services – Medical science has yet to develop a vaccine that eliminates the risk of sexually transmitted diseases or protects a teenager from experimenting with alcohol or drugs. To educate teenagers about the health problems associated with these high-risk behaviors, teenagers need private counseling services that are easy to access and non-threatening.
Services for Women and Infants – Although the state and county provide prenatal services for high-risk women, the infant mortality rate for African-American women is almost twice that of the general population. Additional resources are critically needed in San Diego to reach the highest-risk, most vulnerable women. To minimize the on-again, off-again cycle of historical prenatal programs, county funding must meet the threshold of funding required to address unmet service gaps.
How Do We Start the Reform Process
To initiate the process of reforming San Diego’s health care system, we must look to the County of San Diego’s Health and Human Services (HHS) for vision, leadership and the development resources. Given this commitment from HHS, equal attention must be directed to implementing a chronic disease surveillance program that tracks the incidence of non-reportable diseases, such as cancer, stroke and diabetes (the CDC only requires the county to track certain “reportable” diseases such as tuberculosis, HIV/AIDS and sexually transmitted diseases). Collecting the above data makes it possible to quantify the magnitude of San Diego’s chronic disease problem, as well as to measure any future improvements or decline in rates of incidence.
From a strategic planning perspective, the HHS must then appoint a Health Promotion/Disease Prevention Advisory Council made up of private citizens, public health advocates and health care providers.
The charge to this Council would be to establish a process for addressing the public health issues of all San Diego communities and formulating a strategic plan for future disease education, awareness and prevention initiatives. Over time, this grass-roots public health approach to improving one’s quality of life has the potential of moderating escalating costs of medical care by reducing the demand for services.
Ed Martinez is a resident of El Cajon and former CEO/President of San Ysidro Health Center