An ounce of prevention is worth $12,000 in treatment

Forget socioeconomic identity right now; imagine instead that you're a poor and uninsured woman in your 40s in a poverty-stricken district of Bridgeport. You suffer from hypertension, a chronic illness where your blood pressure exceeds the healthy range. Eventually, the damage to your arteries becomes too severe and whoop! - you're in the hospital being treated for a stroke by a costly regime of physicians, nurses, and equipment.

After envisioning this situation, the natural conclusion is, "Why wasn't I keeping better track of my blood pressure and diet? Could this stroke have been avoided?"

Well, it definitely could have been avoided. It could have been avoided through preventative health care. The thing is though, this imaginary woman is one of more than 300,000 uninsured Connecticut residents who have to rely on community health centers and emergency rooms for primary care. These providers receive reimbursement from public funds primarily for treatment of acute and urgent problems, not for prevention.

These facts are easily observable: despite the fact that in 2007 there were 20,434 patients for hypertension and heart disease in the Connecticut Community Health Centers, the National Association of Community Health Centers lists that these centers have literally no preventative services for chronic illness. And further, treatment-based care is the more emphasized mission of the health care system: the average hospitalization cost for a stroke and congestive heart failure patient in the state during 2006 were $12,013 and $11,248 respectively. So you can do the math: there were 43,340 stroke hospitalizations in Connecticut from just 1995 to 2002.

Now, I'm not saying we shouldn't have these systems to treat urgent medical issues. However, (and it's a big "however"), this system is unbelievably inefficient and there is a vastly superior method. It's called the Department of Public Health. It is a proactive and reactive epidemiological institution that creates programs to actively prevent chronic illnesses and monitor them when they occur. My argument is that the DPH needs to be expanded through increased collaboration with the private health care industry, and especially the community health centers. If this were done, there would be far fewer occurrences of chronic illness. Secondly, it would save the state and tax payers huge sums of money.

How does it keep people healthier? First of all, the standard activities of the DPH include providing affordable immunizations and other basic medical assistance to the public. It also tracks diseases where they occur and checks their expansion through organizing epidemic response systems. Of particular importance though, it establishes in Connecticut "Primary Stroke Centers" - highly-accessible medical care locations where patients can monitor bodily statistics crucial to hypertension and heart disease. Also, the centers offer public lessons in teaching the related symptoms, sophisticated emergency response programs and research to identify effective methods to develop healthier lifestyles. Most importantly, this is combined with the different health care providers so that everyone has easy access.

And how does it save money? Well, that's easy: in 2006, Connecticut spent more than $4 billion of taxpayer funds on medical costs created by stroke and heart disease. That's due to the enormous hospitalization and day-to-day managing expenses these diseases create. If the activities of the DPH were expanded and combined with the private and public health care systems, especially the community health care centers, these costs would be greatly decreased due to the lower rate of occurrence. Accurate statistical forecasting is incredibly difficult, but for every stroke that is prevented by the DPH, the state won't need to spend the $12,000 hospitalization cost. That will add up very fast, figuring that there are annually about 20,000 stroke and heart disease patients.

So let's try to see the DPH expand, let's try to see its responsibilities and activities increase through collaboration with the private health care providers and the community health care centers. If we could do this ­- if we could shift public health care funding from treatment-based medical care to preventative care - the savings in our finances and improvement in our health would be amazing.