Spending for health

In 1999, the North Carolina General Assembly created the Health and Wellness Trust Fund Commission as a result of the tobacco settlement. Our state leaders worked diligently to determine the best use of the settlement moneys for the state of North Carolina. One-quarter of those moneys was set aside to help improve state residents’ health and wellness.

Last week, however, state Senate leaders hatched a plan to divert the money designated for preventing health problems to other programs. To a public- and community-health professional, this makes little sense. The Health and Wellness Trust funds must be maintained for their intended purpose — to improve the health and wellness of the people of North Carolina.

Between 1977 and 1997, I served as public-health director in three different county health departments in North Carolina. During that time, I discovered a fundamental truth: Hospitals, doctors and medical care in general have little to do with human health.

Studies have shown that medical care accounts for only 10 percent of human health, whereas 50 percent can be attributed to health behaviors, 20 percent to genetics, and 20 percent to the environment. In the big picture, the reduction and eradication of disease and premature death in our society is almost always the result of prevention rather than medical care. Armed with this knowledge, I have preached the message of health promotion and disease prevention, lobbying for directing resources to community and public-health endeavors rather than increases in medical services. Today, only 3 cents of the American health-care dollar goes to prevention, while 97 cents goes to medical care.

Despite spending more than any other country in the world on health care, however, the United States ranks embarrasingly low in this area compared to other countries — 37th among 191 nations, according to a report released by the World Health Organization two years ago. The U.S. spends $3,724 per person on medical care each year. Japan — whose health-care system ranked 10th in the report — spends only $1,759 per person. The question is obvious: “Why do we continue to direct such a large portion of our resources toward medical care when it does so little for actual health?” As a society, we must change our health behaviors — and we must use more of our resources to help create healthy communities.

Nothing is more effective than prevention. Supporters of the alternate programs proposed this week for the Health and Wellness Trust Fund moneys might argue that those programs will eventually improve health. But there’s no need to wait. We have many programs already in need of funding that will help prevent health problems.

I close with the following fable, which captures the essence of health promotion and disease prevention. Once upon a time, in a land far away, there was a towering, precipitous cliff. Many a hapless passer-by stumbled over the edge to meet serious injury or death far below. Concerned for the health of the victims, the people of this land built a hospital at the cliff’s base. Those who survived their falls now received prompt, thorough care for their injuries. But one day a child asked, “Why not build a fence along the top of the cliff to keep people from falling at all?”

Perhaps our Senate leaders should answer that question.

[Bob Parker is vice president of Home and Community Health, North Carolina Baptist Hospital and a member of the Health and Wellness Trust Fund Commission.]

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