A study published this month in Health Affairs concluded that 53% of disability could be prevented if the following risk factors were eliminated:
- High Blood Pressure
- High Cholesterol
We know we can’t completely eliminate these risk factors which are driven by diet, physical activity and smoking. Yet, we could dramatically reduce them if we knew how to change human behavior. This change would improve people’s quality of life, reduce healthcare costs and help prevent disability.
The study found that 11% of adults aged 18-54 (estimated 17 million people) reported having a disability as well as 15% of the overall adult population. Preventing disability would improve people’s employment opportunities, family finances and well-being. We could save billions in healthcare costs and disability payments. A study of healthcare costs during 2009-2011 showed that the average adult healthcare cost was $4,845. If adults had 3 or more chronic conditions, their cost were $7,526. If they had a functional limitation and 3 or more chronic conditions the cost was $21,021.
How Do We Modify Human Behavior?
Health insurance dominates the national debate and technology (i.e., new therapies, artificial intelligence) absorbs most of the research funding. Yet, chronic diseases driven by human behavior risk factors may represent the most significant opportunity to improve well-being and lower healthcare costs. The CDC reports that chronic diseases are responsible for 7 of 10 deaths each year and treating people with chronic diseases accounts for 86% of our nation’s health care costs.
Our healthcare system pays for medical treatments and clinical advice, while allocating few dollars to therapies that modify human behavior. We now have only 2.7% of the United States population living a healthy lifestyle (diet, exercise, obesity and smoking).
Numerous studies have shown that 80%-90% of determinants of health are outside of the healthcare system. To address this 80%-90%, we would need to understand people’s everyday activities that impact health and healthcare outcomes. We would need to learn which determinants of these 24 categories are driving behavior that contributes to risk factors such as obesity, high blood pressure, diabetes and high cholesterol.
Once we know why people behave the way they do, the hard part begins. How do we change human behavior? Centers for Medicare and Medicaid Services (CMS), is very interested in finding the answer. They are launching the Diabetes Prevention Program, beginning January 2018 based on a successful program run by a YMCA in Indianapolis. The program provided lifestyle interventions such as a low-fat diet, exercise and 16 one-hour in-person meetings to assist individuals in setting goals and reducing risk factors. CMS estimated that savings was $2,650 for each person enrolled in the program over a 15-month period, more than enough to cover the cost of the program.
Who knows, maybe changing the human behavior that drives risk factors could reduce non-infectious diseases in the 21st century that way vaccinations and antibiotics reduced the scourge of infectious disease and bacteria in the 20th century.