Prevention should be the priority to sustainably lower healthcare spending, according to this children's hospital CEO.
KEY TAKEAWAYS
The U.S. healthcare system focuses on treating chronic diseases rather than investing in childhood prevention, which could lead to a healthier, more productive population.
Early childhood education and small interventions can prevent obesity more effectively than costly drugs, reducing long-term healthcare costs.
Editor's note: R. Lawrence Moss, MD is the president & CEO of Nemours Children’s Health, based in Jacksonville, Florida.
Recently, I sat with a peer group of CEOs of some of the largest and best medical centers in the country. The topic at hand was the impending massive cost of weight loss drugs (GLP-1 agonists) and how we as a healthcare system and a society were going to pay for these drugs. Thoughtful estimates of potential costs exceeded tens of billions of dollars and only went up from there.
As a children’s hospital CEO, I had empathy for my adult colleagues who deal every day with a massive burden of chronic disease. They are charged with supplying expensive, complex therapies that can only slightly mitigate the inexorable progression of the four major killers in the US: diabetes, heart disease, cancer, and Alzheimer’s.
I made the comment, which fizzled like a wet firecracker, that if we spent a tiny fraction of that sum on early childhood education, we could reduce the incidence of obesity far more effectively than even the greatest wonder drug. As our government seeks to trim spending and find cost efficiencies, the prevention of chronic disease in adults would be the ultimate cost saver, dramatically lowering our spending on Medicare and Medicaid while increasing worker productivity.
On the way home, I read a recent study in the journal Science finding that children conceived and born in Britain at a time of sugar rationing during World War II grew up to have a markedly lower incidence of diabetes and high blood pressure than children born shortly after rationing was lifted.
This juxtaposition of events was a perfect example of what is wrong with healthcare in America. We address every problem in health, even those whose causes are non-medical social drivers of health, by throwing expensive medical care at it. The U.S. has a rate of obesity that is by far the highest among our peer nations. This is not because we are genetically different than our overseas friends. It is not because we have contracted an infection that causes chronic disease. It is because the American lifestyle has caused rampant obesity. Rather than even consider changing the American lifestyle, we have invented expensive new drugs to combat obesity with medical care rather than prevention.
We have known for decades that small, inexpensive interventions in children can have a massive impact on adult health. In the mid-1970s, the Abecedarian Project, led by Nobel Prize winner James Heckman, provided high-quality childcare to two groups of kids from birth to age five, emphasizing language, conversation, and learning games. They added nutritional education and a healthy snack in one group. It then followed these children for decades. In their 30s, the group that had the nutrition intervention had markedly lower rates of hypertension than their peers, were less obese, and not a single one had metabolic syndrome, which often leads to heart disease, stroke, and diabetes. It also improved their employment status, their income, and reduced criminal activity among male participants. Heckman’s later work found there were even multigenerational positive health effects on the participants’ children.
Society would reap the benefits in a healthier, longer-living workforce. But it’s important to note who would lose: processed food companies that keep people coming back with added sugar and fat; hospital systems that—in fee-for-service America—are designed to profit from treating illness; and pharmaceutical companies that make money by treating chronic disease. Are we willing to make the simple, inexpensive changes in childhood that make Americans healthier and save money in the process, or are we simply too accustomed to profiting from illness?
Our system is not incentivized to behave this way, nor to spend its money this way. Only 7% of healthcare dollars in this country are spent on children, and forms of social spending directed toward child health or long-term human health are not seen as a form of healthcare.
We must address non-medical threats to health with direct interventions that address the root causes, not with expensive high-tech medical care once the disease is established. Investing in child health is the single most powerful lever we have to create the healthiest generations of Americans and the most robust economy. We must summon the will to pull it.
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