A couple weeks ago I wrote about whether prevention can really cut health-care costs. Given America’s troubling chronic-disease rates, however, a more pertinent question might be this: Can health-care workers actually implement prevention on behalf of their patients? Sure, there’s cancer screening and annual check-ups. But that’s not usually what people mean when they talk about prevention in their own lives. They’re talking about eating right, getting some exercise, quitting smoking, and all those other lifestyle changes that we already know we should be making — but generally don’t. Does having doctors and nurses involved really make people more likely to do what they already know is best?
The little evidence that’s out there suggests that, yes, in fact, it does. Randomized trials show that merely having a doctor recommend smoking cessation will make people more likely to try to quit, and having doctors recommend an exercise plan will make people more likely to get up off the couch. Yet doctors don’t always do these things for patients who would benefit.
Recently I paid a visit to a health center in Philadelphia to see how prevention can work in practice. The 11th Street Family Health Services of Drexel University offers an intensive prevention model. There, people with diabetes aren’t just given advice on what they should eat to stay healthy; they’re encouraged to attend special cooking classes and food-tasting sessions that will actually make them do it. When a different program for diabetics — a chronic disease management course — didn’t seem to be working a while back, the staff tried to find out why. They found high rates of depression among the patients, a sense of helplessness that was preventing people from making changes. So they worked hard to get patients to enroll in programs that dealt with that too.
The center’s results seem very impressive. So many ordinary patients seemed to be making lifestyle changes. But one thing that struck me is how hard it still might be to make 100 carbon copies of the center and spread similar prevention-based clinics all around the country. Because what really seems to work best—what truly makes the center preventative rather than reactive—is adaptability. Staff find problems and fix them: whether it’s a need for depression counseling or for stray dog removal. That takes a deep knowledge of your local environment that’s tough to replicate and roll out nationwide. Even though, in the end, it certainly does make patients a little more receptive when health-care workers suggest, hey, maybe you should come to a cooking class for diabetics, or quit smoking, or exercise more—and do all the other things you know you should be doing but aren’t.