Why preventative care is such a tough sell in the U.S., according to chronic disease experts

WASHINGTON — With the prevalence of some chronic diseases trending up, the U.S. needs to revamp its approaches to preventative care and disease management, experts said at the Milken Future of Health Summit on Tuesday.

Already, 6 in 10 Americans live with a chronic condition, and 4 in 10 live with at least two. Factors such as the U.S.’s aging population, delayed care during Covid-19, and the rising prevalence of obesity are only exacerbating the problem, said Karen Hacker, the Centers for Disease Control and Prevention’s director for the National Center for Chronic Disease Prevention and Health Promotion.

“We have amazing innovation in this country, we have incredible pharmaceuticals in this country, but we have literally, I’d say, disinvested in prevention,” Hacker said.

Anand Parekh, chief medical adviser for the Bipartisan Policy Center, pointed to the shortage in primary care physicians and the fee-for-service health care model as major hurdles for the future of chronic disease prevention and management.

“Fifty years ago in this country, half of clinicians were primary care physicians, half were specialists,” he said. “We’re now at a point in this country where only about 20 to 25% are actually in primary care. I think we need to look at workforce-related issues, payment-related and reimbursement-related issues, to really elevate the primary care workforce.”

Preventative action can be a hard sell for policymakers, however. Improved health outcomes take time and require good data monitoring, said Parekh.

“The efforts in prevention take time to accrue the benefits when it’s health outcomes, and policymakers have to be patient,” Parekh said. He added that positive outcomes with preventative care are often “difficult to demonstrate or show because something didn’t happen.”  

One of the biggest challenges for public health efforts is dispersed patient data. Chronic condition diagnoses, such as diabetes, are not tracked and reported in the same way as infectious disease outbreaks — a problem that Hacker and the CDC hope to someday address.

“The data is everywhere. It’s in every health care system, it’s in every insurance system. People are moving between those all the time, so it’s hard to really identify who’s who. That is certainly one of our challenges, and right now we’re actually involved in an effort to look at a comprehensive approach to chronic disease monitoring for the nation,” Hacker said.

Amid the rise in Alzheimer’s disease due to the U.S.’s aging population, public health officials are also advocating for more integrated prevention approaches. Although the risk factors for cardiovascular disease, diabetes, and hypertension can increase the likelihood of developing Alzheimer’s disease and dementia, the approaches to chronic disease prevention have traditionally been siloed. 

“When we look at these risk factors, they really do carry across,” said Kristen Clifford, chief program officer at the Alzheimer’s Association. “One thing you’ll hear me say is, ‘What’s good for your heart is good for your brain.’ But how are we messaging that to the public, how are our health care providers messaging that?”

According to Hacker, better chronic disease prevention also depends on non-medical interventions. The social determinants of health — which include access to food, housing, transportation, and other factors — play a major role in people’s health outcomes. The public health sector is looking at more upstream strategies to reduce these disparities.

“As we’re seeing these types of strategies unfold, and the health care system becoming more engaged in social determinants … my hope is that we in public health can amplify those messages,” Hacker said. “That we can essentially wrap ourselves around what’s happening in the clinical delivery system with the individual to really think about populations.”