When we think about yoga, or eating well (mostly plants!) we often think we are preventing disease, striving to live a longer, healthier life…and I think for most of us, that’s exactly what we’re doing.  After all, the common sense use of the word prevention is to stop something from happening.  So when we say we want to ‘prevent’ disease, that’s exactly what we mean.  Do more yoga, eat healthier food, minimize your stress.  Prevent disease!

But what does it mean when the government talks about ‘prevention’ in the new health care law? or when many health care professionals talk about prevention? Here’s the primer part…

In health care circles we talk about 3 kinds of prevention, only one of which is what you and I would call prevention…..its like this….

Primary Prevention – this is really preventing something from occurring. When we lose weight or stop eating meat, we lower our risk profile in the hopes of staying healthy, feeling vigorous, living longer. Common sense lets us understand that having a body mass index (BMI) less than 25 doesn’t mean we won’t have a heart attack, but it does mean the odds of having a heart attack are lower than if my BMI is 30. PREVENT DISEASE

Secondary Prevention – this is the majority of what made it into the health care law as ‘prevention’.  In the health care world, we speak about early detection as prevention.  So, if I’m a doc, and I find out someone has cancer during an office visit, because I did a test, then in health care jargon, I am doing secondary prevention.  In the way we talk with our friends, I didn’t really prevent anything, what I did  was find out someone was sick.  What I did prevent was the disease remaining untreated, and because I have detected the disease, I can minimize the damage from the disease – I caught it early.  That’s secondary prevention. MINIMIZE DAMAGE

Tertiary Prevention – once again, we are not talking about preventing disease when we do tertiary prevention.  Here we are talking about minimizing suffering. When someone is chronically ill, and living with the symptoms of their disease, by practicing this form of prevention we enhance their quality of life.    MINIMIZE SUFFERING

Tbere’s alot of activity around prevention as the Affordable Care Act is being implemented at a state and national level.  Here’s a conversation with Dana Goldman, director of the Schaeffer Center at the University of Southern California and  editor of the Forum for Health Economics and Policy.  Dana is talking with —– at the NYTimes about taking a “A Long View on Health Care”  The conversation focuses on primary prevention (without making this distinction) and suggests the possibility of  thinking like an investor…ie, considering investing upfront (practicing prevention early on) to achieve an return on our investment (lower health care costs and increased quality of life).  This is the work we do, day in and day out….person by person, moment by moment…make healthier choices, build healthier habits, create a healthier eco-system to live in!

Rich