“When the gospel of prevention shall have been effectually preached, and its doctrines embraced by the people, the medical hero will not be he only who sacrifices his life in ministering to those dyingbut he also who shall teach the people how to prevent these diseases.”
Kansas State Board of Health, First Annual Report, 1885
By Mike Shields
KHI News Service
Roderick Bremby, secretary of the Kansas Department of Health and Environment, was the strongest advocate for prevention and healthy living incentives in the health reform plan crafted by the Kansas Health Policy Authority for consideration by the 2008 Legislature. Bremby is a non-voting member of the authority”s board. He is pictured here talking to fellow board member Ned Holland. (Dave Ranney/KHI)
TOPEKA, Nov. 19
When the Kansas Health Policy Authority board was crafting the health reform plan that will be considered by the 2008 Legislature, board member Roderick Bremby, secretary of the Kansas Department of Health and Environment, was the most consistent and outspoken advocate of including measures to encourage prevention and healthy living.
When the board met in August, it was mostly focused on the question of how to expand health insurance coverage to more Kansans. But Bremby gave a special Powerpoint presentation in an effort to make his case that expanding access to health care would do relatively little to deal with the underlying problems of a population that is growing more obese and otherwise susceptible
to preventable and costly chronic illnesses.
During his presentation he showed a picture of water flooding a kitchen and told members that expanding insurance coverage would be like mopping the floor without turning off the faucet in the kitchen sink.
He threw out alarming statistics:
* Treating chronic disease accounts for 75 percent of national health care costs.
* Chronic disease cost Kansas an estimated $10.7 billion in 2004.
* 30 percent of people account for 90 percent of health care costs.
“We are not focused on health outcomes,” Bremby told fellow board members and the audience.
He quoted Hippocrates: “The function of protecting and developing health must rank even above that of restoring it when it is impaired,” and Henry De Braction: “An ounce of prevention is worth a pound of cure.”
Click here for larger size. (Cathy McNorton/KHI)
He showed a pie chart indicating that medical care accounts for a relatively small percentage of what determines our health. Genetics, the physical and social environments in which we live and the lifestyle choices we make have greater influences.
He flashed on the wall a slide that showed the leading causes of death in the U.S. are tobacco, poor diet and lack of exercise, and alcohol.
In the end, 11 of the 21 components of the health reform plan presented Nov. 1 to the Legislature by the health policy authority dealt with prevention. And two of those were already included in the budget KDHE had presented for review by the governor.
“One of the slides I used in that (health policy authority presentation) talked about the factors that contribute to health status. Unfortunately, most of the focus (in health reform talks around the country) is on access, but that”s only about 10 percent of what affects health,” Bremby said. “Clearly, it”s our behavior and the environments in which we live that have a very, very large role in determining how healthy we are.”
Bremby said his thinking on the subjects of prevention and the social determinants of health were influenced by scholars such as Ichiro Kawachi, a professor of social epidemiology at Harvard University”s School of Public Health, and experiences he had when he was assistant city manager in Lawrence. There, the community successfully dealt with a juvenile crime problem by using a broad-based approach that included adding middle school football programs, tougher police response and other measures aimed at getting to the root of the problem.
When he left the city job in 2000, it was to work as associate director at the University of Kansas Work Group on Health Promotion and Community Development. He said he also started working on a doctoral dissertation, focusing on social determinants of health.
But he abandoned that to become secretary of health and environment, a post that also got him on the health policy authority board as a non-voting member.
Bremby said he felt it was part of his job to make the case for prevention as the
health reform plan
was being drafted.
“I think our role at KDHE in this process is to keep the focus on prevention,” he said. “Others can do much more in the realm of access and insurance.”
Bremby said though the plan doesn”t include everything the department would have liked, it has “some fundamental things we can build on.”
The prevention and personal responsibility components of the reform package, he said, focus on the three “modifiable behaviors” that contribute to the “chronic illness and disease which is 80 percent of our health care costs.”
The three behaviors:
* Physical activity
* Good nutrition
* Avoiding tobacco and tobacco exposure
The reforms call for a statewide smoking ban in public places and an increase in the excise tax on tobacco products.
Key legislators have already said smoking bans are a matter best left to local governments.
“We know that is a contentious issue,” Bremby said. “But there again, Kansas is not on the cutting edge. It”s already been done in 27 or 28 states. There”s some really good data to show potential savings” in health costs resulting from decreased tobacco use resulting from bans and tax increases.
The proposed KDHE budget for 2009, though it is not yet approved by the governor, includes a request for an additional $6 million from the state general fund for expanded cancer screenings through the agency”s Early Detection Works program.
The program currently offers screenings for breast and cervical cancer for low-income women. With the new money it also would offer screening for prostate and colon cancer.
Bremby said the screenings “ultimately save money because they detect illnesses earlier when treatment is more likely to be effective and less costly.”
The agency also is asking for $1.8 million to expand the Coordinated School Health program to include all public schools in each of the state”s 299 school districts. Currently the program, which emphasizes physical activity, good nutrition and other healthy behaviors, operates in 224 schools in 52 districts. It is a joint project of KDHE and the state education department.
“They have tried some things and made some tremendous gains,” Bremby said of the program.
He cited the Jefferson West school district in Meriden as an example. Among other things, the district replaced junk food in the vending machines with healthier alternatives, something some schools have chosen not to do for fear of losing the money they earn as a percentage of the machine sales.
Jefferson West schools “stocked the vending machines with healthy items and have seen an increase in revenues,” Bremby said.
He said lawmakers should adopt all 21 of the reforms proposed because the plan “is a comprehensive approach. It needs to be taken together. As a package, it really can”t be disaggregated. There are a lot of things that didn”t get into the plan. These are the things we think are critical now.”
-Mike Shields is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at
mshields@khi.org
or at 785-233-5443, ext. 123.