Preventive Medicine: Improving U.S. Health by Changing Habits

Q&A with UAlbany School of Public Health Dean Dr. Mary Applegate

Increasing accesss to healthy foods is a key to reducing health care costs and improving the health profile of the U.S. population, according to Dr. Applegate.

As Medicaid rolls swell and health care expenses balloon across the United States, legislative leaders are grappling with ways to improve health outcomes while reducing costs. UAlbany School of Public Health Associate Dean Dr. Mary Applegate discusses the role of preventive medicine as a mechanism for improving health.

Q: How are health priorities currently set in the United States?

A: In public health, we worry about questions such as: "What's the most likely cause of death for people in our community?"  For many years we looked to the "Cause of Death" line on death certificates to answer that question, and we came away saying that heart disease, cancer, and stroke are the top causes.

Unfortunately, that answer has led us to think that what we need to do to prevent deaths is to build high-tech hospitals and to train highly specialized physicians.

Dr. Mary Applegate

Q: Is this approach successful?

A: That approach hasn't worked so well.  The U.S. ranks near the bottom among industrialized nations in measures such as infant mortality and life expectancy.  We're also at the top in how much we spend on health care.

Q: How would a preventive medicine approach set health policy?

A: We need to look at data in a different way -- a way that was first proposed by James McGinnis & William Foegy in a 1993 JAMA article entitled "Actual Causes of Death in the United States."  Drs. McGinnis and Foegy, leaders in the U.S. Department of Health & Human Services at the time, analyzed what the underlying behaviors were that contributed to heart disease, cancer, and the other top causes of death.  They concluded that tobacco use, poor diet, and physical inactivity were the leading actual causes of death.

From that perspective, to prevent deaths we need to do the following:

• restrict tobacco access & advertising so that kids won’t take up the habit,
• help people quit smoking,
• build walkable communities,
• promote breastfeeding, and
• increase affordability and access to healthy foods so that people reach for an apple instead of a bag of potato chips when they're hungry.

Dr. Mary Applegate served for many years as medical director in the Bureau of Women's Health at the New York State Department of Health, overseeing programs in maternal and infant health, family planning, adolescent pregnancy prevention, osteoporosis prevention, and sexual assault. She has conducted research on breastfeeding promotion and maternal mortality prevention. She also directs the New York State Preventive Medicine Residency Program and is a member of the American College of Preventive Medicine's Board of Regents.

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