We might never know the true benefits of efforts to improve public health
Prevention efforts are running into some curious hurdles
Sometimes it seems as if the term “prevention” has become the equivalent of a four-letter word.
With increasing frequency, government initiatives intended to apply some preventive approaches to our nation’s public health challenges are met with suspicion if not derision.
First lady Michelle Obama certainly knows all about that, given the scorn heaped upon the program she is spearheading that targets childhood obesity. The initiative, dubbed “Let’s Move!” and now a year old, never should have been a controversial endeavor.
What’s wrong with finding new ways to entice kids to step away from the TV or Xbox for a while and prod them into getting some exercise? Isn’t it a worthy effort to nudge our nation’s schools to offer less “junk” in the cafeteria and more nutritious yet tasty choices? Chef Jamie Oliver has made it his mission to prove that it’s not only possible to do this, but kids even like it.
Of course the critics of Obama’s initiative saw it as just more wasteful spending. And they warned of “food police” tyranny and the “heavy hand” of government robbing our youth of their trans-fats.
Yes, billions of dollars are at stake in governmental prevention efforts. And we know that in large-scale initiatives, the numbers often don’t add up, at least if the metric is healthcare cost savings. The “return on investment” often disappoints because the programs often become cost drivers, at least initially, rather than savings generators. But that’s not the final word.
In our May 9 cover story titled “Does prevention really pay?” the takeaway is that there really isn’t a cut-and-dried answer to the question. However, as one expert noted, attempts at quantifying savings from prevention efforts can “vastly underestimate the cost-benefit … because they don’t include all of the indirect costs and benefits involved.”
One of the most recent assaults on common-sense prevention efforts comes courtesy of the Florida Legislature, which this spring approved and sent to Gov. Rick Scott a bill that aims to muzzle physicians—most specifically pediatricians—in their attempts to head off serious injuries. The issue? Guns. The bill, with some critical exceptions, makes it illegal for doctors to ask patients about whether they have firearms in their homes. Such questions are often asked during well-child checkups as part of counseling new parents about common hazards in the home and how to mitigate them. To sponsors of the bill, however, the questions are an invasion of privacy.
The fines are set at $500 and can escalate for multiple offenses. Earlier drafts of the bill included imprisonment and fines of as much as $5 million. All for asking a question that just might prevent the injury or even death of a child. According to a national estimate from the Centers for Disease Control and Prevention, there were nearly 3,600 unintentional nonfatal firearms injuries among those age 19 or younger in 2009.
What about the free-speech implications of the bill? This is a patient-physician conversation in which doctors also might ask about many other potential hazards such as access to swimming pools, poisons and toxic household products. Are those offlimits, as well?
The questions are no threat to Americans’ Second Amendment rights. They have been asked over the years and clearly haven’t inhibited gun ownership. And it’s always the patient’s choice to decline to answer.
What’s specific to guns is just how unforgiving an accident can be. And toddlers seem to have an uncanny knack for finding objects that parents thought were safely locked away.
This is legislation that should be locked away. Doing so could prove to be some highly effective preventive medicine.