Dr. Tom Friedan, director of the U.S. Centers for Disease Control and Prevention, has helped define six “winnable battles” for improving the public’s health in the next one to four years.
Some of these battles will be won in the legislature, some in hospitals, some in medical offices, and all in our communities. What are these six battles?
The first is tobacco control.
Tobacco is the leading preventable cause of death, killing 440,000 people annually in the U.S., and the largest potential public health threat.
Forty percent of adult nonsmokers and 54 percent of children aged 3 to 11 years are exposed to secondhand smoke in the U.S. One-hundred ninety-three billion dollars are wasted in medical expenses and lost productivity.
Tobacco use can be addressed by increasing the price of tobacco products, promoting evidence-based policies, supporting 100 percent smoke-free environments, using aggressive earned and paid media, and supporting FDA regulation.
The second battle is nutrition, physical activity, obesity and food safety.
From 1980 to 2000, obesity rates doubled for adults and tripled for children. Reducing salt intake equates with 100,000 fewer deaths annually. Eliminating artificial trans-fat equates to tens of thousands fewer deaths annually.
We have a complex, globalized food supply with tens of millions of food-borne illnesses reported annually. This problem can be addressed by changing the environment to promote healthy food and active living, addressing food procurement and improving food-borne illness detection, response and prevention.
Third is health care associated infections.
These affect one in 20 patients in U.S. hospitals annually. They increase costs, length of hospitalizations and deaths.
These preventable infections occur in blood streams, urinary tracts and surgical sites. They can be addressed by strengthening national surveillance through the National Healthcare Safety Network, increasing implementation of evidence-based prevention guidelines in hospitals, ensuring federal and state policies to support transparency and accountability, sustaining health care associated infections programs in states, and expanding prevention to nonhospital settings.
Fourth is motor vehicle injuries.
These result in 45,000 deaths and four million emergency department visits each year. They are the leading cause of death in the first three decades of life.
They can be addressed by promoting 100 percent seat belt use, which would result in 4,000 fewer fatalities annually; reducing impaired driving, which would equal 8,000 fewer fatalities annually; supporting strong Graduated Drivers License policies, which would equal 350,000 fewer nonfatal injuries and 175 fewer deaths annually; and collaborating with the transportation sector and other agencies to promote safety policies.
Fifth is teen pregnancy.
The teen birth rate remains high. Two-thirds of pregnancies under age 18 are unintended.
Teen pregnancy can perpetuate a cycle of poverty. It increases infant death, low birth weight, preterm birth and health care costs. The taxpayer cost of teen pregnancy is greater than nine billion dollars per year.
Teen pregnancy rates can be reduced by increasing access to reproductive health services, especially long-acting reversible contraceptives; reducing cost barriers to family planning services and contraceptives; and working to change health professional and community norms.
Finally, there is HIV.
1,100,000 Americans have HIV, one out of five are unaware they are infected.
The estimated lifetime cost of HIV is more than $380,000 per person for direct medical care. This problem can be addressed by increasing HIV testing to reach all Americans, providing access to proven interventions such as comprehensive sex education and condom education; improving access to health care and stressing prevention with individuals who are HIV positive.
So, can we win these battles? The answer is yes. We have a proven track record in all these areas in Maine.
We have come a long way, but there is still much work to be accomplished. This will work best with the combined efforts of the medical profession and their public health colleagues. Together we can win these battles and when we do, Maine will benefit.
Dr. Stephen D. Sears serves as the state epidemiologist with the Maine Center for Disease Control and Prevention.