"We need to spend more on prevention" debated

Nurses Activism

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Specializes in Critical Care, Insurance Case Management.

I keep hearing all this talk about how the emphasis in medicine needs to be on prevention of disease, and not disease management or cures. As a nurse with over 20 years experience in a variety of clinical and business settings, most recently in mental health, I would like to suggest the new paradigm of prevention first is a bit mis-guided and unrealistic.

First, what is prevention? How do you realistically "prevent" obesity, high blood pressure, diabetes, heart disease? There are only 2 ways to affect these chronic diseases: education or dictate. The health community has focused on education for 40 years. Constant repetition on message has slowly changed the numbers of unintended pregnancy, smoking, STDs, and AIDS related illness. There are other examples too, but changing behavior is a slow process. Education alone does not prevent chronic medical problems, at least not quickly.

So the new health reform thinks they can prevent first, limit the expensive care to a few choices at the end of life, and suddenly every one in this country will have excellent universal care that is cost effective, paid for, and even reduce the deficit. Only one problem: you can't dictate behavior.

This is the only way large scale changes could lead to the kind of Utopia one side of the spectrum is envisioning for this county. If you punish behavior that causes chronic disease, it is the only way to effect change rapidly. So, your freedom to choose is taken away, "for your own good" because people left to their own devices will not make smart choices. Outlaw transfats, outlaw tobacco (so why is it still legal if you really want people to quit smoking?) Outlaw sugar, outlaw meat (global warming), remove all snacks except fruit and vegetables from the school vending machines, tax complex carbs to reduce useage, mandate 1 hour of exercise daily for all citizens, fines for BMI over 30, fine smokers. I know - maybe you could just remove food and use compressed supplements with all the recommended nutrition. And those weak humans to do develop diabetes, or high blood pressure, or have too much fat? What do we do with them, after all our "help" controlling their weakness?

Maybe it is time to re-read Brave New World, Farenheit 451, Animal Farm, and Soylent Green. As for me, I prefer the education route, and continue to fund research in to cures. This may be a bit tongue-in-cheek, but this pie in the sky talk about prevention, not cure or treatment of disease seems to ignore the human factor and the gift of free will. I don't want government to take that away from me. Positive reinforcement has always worked better to change behavior than punishment, and yet in this new world of reform, the only way to prevent disease is to punish the behavior that causes it.

Specializes in LTC.

I think if people had more access to make healthy decisions, they would make them. Cost is a big factor here, consider the fact that eating a meal at McDonalds is far cheaper than going to the market and eating a sensible, healthy meal.

Prevention through education has shown results. If people have the information they need, AND if they have the resources to make healthy decisions, they will make them.

They already do pretty much everything you're talking about. Cigarettes are taxed, with state and federal taxes, somewhere around 75-100% here. Theres already talk about taxing sodas and sugary foods. And it absolutely is removing freedom of choice.

I think if people had more access to make healthy decisions, they would make them. Cost is a big factor here, consider the fact that eating a meal at McDonalds is far cheaper than going to the market and eating a sensible, healthy meal.

Prevention through education has shown results. If people have the information they need, AND if they have the resources to make healthy decisions, they will make them.

I assume you're building up to insinuating that we should tax fast food to make it more cost efficient for people to eat healthy, thus once again removing our freedom of choice for "our own good". It seems every post I run into from you is just...notoriously uninformed. Unless you live in the isolated plains of alaska, you're full of it. I -never- purchase fast food, simply because of the price.

A chicken sandwich, or a quarter pounder if you prefer, costs about 4 bucks here. Burger alone. With the standard fries and drink that always accompanies it. You're looking at about 5-6 bucks. So about 20 bucks for a family of four.

1 pound of boneless skinless chicken breast (3 servings) = $4.00 a pound here. (2-3 when its on sale)

Steamed fresh vegetables (3 servings) = $1.50

Refridgerated mash potatoes (3 servings) = $3.00

Throw in a nice healthy glass of water from the tap at no cost. Comes out to about $8.50 for three servings of healthy home cooking. And allow me to anticipate your counterargument that people don't have the time.

Fresh ground beef patties? 4.00 (4 servings)

Buns/condiments? 1.00 (4 servings)

French fries, or...since we're going healthy, a baked potato for each. $2.00(4 servings)

Total cost, 7 bucks for 4 servings.

Lets not even get into all the super healthy super cheap options that are out there. Pasta, tuna, fish, eggs, salads, vegetables etc. None would even BEGIN to touch 5 bucks a serving for a full meal, and about the same amount of prep time as it would take you to drive to your nearest burger joint.

Cost isn't a factor whatsoever when it comes to healthy habits. You pay for your vices. People go to fast food

because they're lazy and they don't want to cook. And because, well...the food tastes really really good.

Specializes in LTC.
They already do pretty much everything you're talking about. Cigarettes are taxed, with state and federal taxes, somewhere around 75-100% here. Theres already talk about taxing sodas and sugary foods. And it absolutely is removing freedom of choice.

I assume you're building up to insinuating that we should tax fast food to make it more cost efficient for people to eat healthy, thus once again removing our freedom of choice for "our own good". It seems every post I run into from you is just...notoriously uninformed. Unless you live in the isolated plains of alaska, you're full of it. I -never- purchase fast food, simply because of the price.

A chicken sandwich, or a quarter pounder if you prefer, costs about 4 bucks here. Burger alone. With the standard fries and drink that always accompanies it. You're looking at about 5-6 bucks. So about 20 bucks for a family of four.

1 pound of boneless skinless chicken breast (3 servings) = $4.00 a pound here. (2-3 when its on sale)

Steamed fresh vegetables (3 servings) = $1.50

Refridgerated mash potatoes (3 servings) = $3.00

Throw in a nice healthy glass of water from the tap at no cost. Comes out to about $8.50 for three servings of healthy home cooking. And allow me to anticipate your counterargument that people don't have the time.

Fresh ground beef patties? 4.00 (4 servings)

Buns/condiments? 1.00 (4 servings)

French fries, or...since we're going healthy, a baked potato for each. $2.00(4 servings)

Total cost, 7 bucks for 4 servings.

Lets not even get into all the super healthy super cheap options that are out there. Pasta, tuna, fish, eggs, salads, vegetables etc. None would even BEGIN to touch 5 bucks a serving for a full meal, and about the same amount of prep time as it would take you to drive to your nearest burger joint.

Cost isn't a factor whatsoever when it comes to healthy habits. You pay for your vices. People go to fast food

because they're lazy and they don't want to cook. And because, well...the food tastes really really good.

:lol2:

Fast food sales are going up, not down. To deny that we are consuming more and more because of price is ridiculous.

And all that garbage we eat from the grocery stores mostly masquerades as food. Meat is produced nowadays on factory farms and livestock are fed corn. There's been a disturbing trend over the years of E. Coli outbreaks that directly correlates to feeding livestock corn. But, the "good" news is, the meat manufactures are now treating this tainted meat with ammonia, so, I guess that solves the problem.

Fresh fruits and veggies are a misnomer, they are treated and genetically modified to such an extent that they hardly pass as "food".

Fast foods companies exploit three basic evolutionary cravings of the human apetitie, salt, sugar and fat. If we consider with the fact that Americans are very busy people, convenience comes into play. The label of "laziness" for this problem is thrown around too often, and I suspect it's coming from people (like yourself) who don't have the first clue what they are talking about.

My position stands, to eat truly safe, healthy food is expensive. If people had accurate information and the means to acquire healthy food, and the time to prepare it, we would see a less disease.

Specializes in OB, NICU, Nursing Education (academic).

Eating safe, healthy food is expensive.....but A LOT more affordable when people put down those cigarettes and 6-packs!

Disease prevention in many (not all) cases requires personal responsibility, therefore, it'll never get popular support (sadly).

Specializes in LTC.
Eating safe, healthy food is expensive.....but A LOT more affordable when people put down those cigarettes and 6-packs!

Disease prevention in many (not all) cases requires personal responsibility, therefore, it'll never get popular support (sadly).

I couldn't agree more. My state has a very high rate of smokers. And I read recently that smoking nationwide has seen an increase.

I do believe that personal responsibility has a hand to play here, the good news is, we are seeing it demonstrated AEB the increased demand of healthy "un-messed with" food, such as food sold at farmers market's and organic groceries. As demand increases, more people will jump in to fulfill the need. But, personal responsibility is one part of the equation.

Why is it, that our schools have soda machines and vending machines that sell junk?

I think if people had more access to make healthy decisions, they would make them. Cost is a big factor here, consider the fact that eating a meal at McDonalds is far cheaper than going to the market and eating a sensible, healthy meal.

Prevention through education has shown results. If people have the information they need, AND if they have the resources to make healthy decisions, they will make them.

I am currently on the border of Vermont and New Hampshire. Milk in Vermont is $2.89 a gallon and $4.89 a gallon in New Hampshire. New Hampshire has a subsidy for it's dairy farmers instituted by the STATE GOVERNMENT. Soda is .99 cents for 2 liters.

Actually, there is study that shows smoking has slightly increased in adults. So education doesn't work.

We give patient's information 3 times a week, 52 weeks a year and still they gain too much work. We try to get fistulas in patients vs CVC's and we have a poster showing the catheter almost into the heart and yet people won't go get a fistula.

Most people are gonna do what they want they aren't gonna do what they don't want to do.

Don't you find it interesting that the media is encouraging people to wash their hands to avoid the spread of the flu. Do we really need to remind adults to wash their hands? Do they not know that there are germs on their hands?

They already do pretty much everything you're talking about. Cigarettes are taxed, with state and federal taxes, somewhere around 75-100% here. Theres already talk about taxing sodas and sugary foods. And it absolutely is removing freedom of choice.

:lol2:

Fast food sales are going up, not down. To deny that we are consuming more and more because of price is ridiculous.

And all that garbage we eat from the grocery stores mostly masquerades as food. Meat is produced nowadays on factory farms and livestock are fed corn. There's been a disturbing trend over the years of E. Coli outbreaks that directly correlates to feeding livestock corn. But, the "good" news is, the meat manufactures are now treating this tainted meat with ammonia, so, I guess that solves the problem.

Fresh fruits and veggies are a misnomer, they are treated and genetically modified to such an extent that they hardly pass as "food".

Fast foods companies exploit three basic evolutionary cravings of the human apetitie, salt, sugar and fat. If we consider with the fact that Americans are very busy people, convenience comes into play. The label of "laziness" for this problem is thrown around too often, and I suspect it's coming from people (like yourself) who don't have the first clue what they are talking about.

My position stands, to eat truly safe, healthy food is expensive. If people had accurate information and the means to acquire healthy food, and the time to prepare it, we would see a less disease.

I'm 58 years old. We always fed our cows corn. What do you suppose silage is. It's corn stored in a silo for winter feeding. Deer love corn and deer meat, especially tenderloin, is lean and delicious.

Are you saying that running throught the drive through is hard work? OMG.

Then why has the lifespan improved over the years, the same years that consumption of fast food has skyrocketed. Why was the lifespan lower when all you could get were home grown veggies and home grown poultry, beef, and pork?

I couldn't agree more. My state has a very high rate of smokers. And I read recently that smoking nationwide has seen an increase.

I do believe that personal responsibility has a hand to play here, the good news is, we are seeing it demonstrated AEB the increased demand of healthy "un-messed with" food, such as food sold at farmers market's and organic groceries. As demand increases, more people will jump in to fulfill the need. But, personal responsibility is one part of the equation.

Why is it, that our schools have soda machines and vending machines that sell junk?

The answer to your last question is that the GOVERNMENT can't adequately fund a basic right to education in this country. Those schools need the revenue from those machines. When those machines are taken out of the schools it's been found that kids keep their money and actually spend more at the local 7-11 on the way home.

I am currently on the border of Vermont and New Hampshire. Milk in Vermont is $2.89 a gallon and $4.89 a gallon in New Hampshire. New Hampshire has a subsidy for it's dairy farmers instituted by the STATE GOVERNMENT. Soda is .99 cents for 2 liters.

Actually, there is study that shows smoking has slightly increased in adults. So education doesn't work.

We give patient's information 3 times a week, 52 weeks a year and still they gain too much fluid. We try to get fistulas in patients vs CVC's and we have a poster showing the catheter almost into the heart and yet people won't go get a fistula.

Most people are gonna do what they want they aren't gonna do what they don't want to do.

Don't you find it interesting that the media is encouraging people to wash their hands to avoid the spread of the flu. Do we really need to remind adults to wash their hands? Do they not know that there are germs on their hands?

Education is nice but it doesn't work.

Specializes in Critical Care, Insurance Case Management.

Actually education does work, it is just very slow and requires constant repetition. Mental health was an excellent experience in life, as it shows you working with Borderline Personality Disorder you have to be happy with tiny changes in behavior over a long period of time - patience and repetition works; but throwing tax payer money at teaching does not! Sometimes resistance to change can be affected by a lightbulb moment - like the day I realized a taco salad at Taco Bell was over 1000 calories - I never went back to Taco Bell again, and that was over 20 years ago. My client with BPD HATED yogurt, and refused to eat it, until she tried one she decided she liked; now she buys it all the time, after 2 years of counseling about gastroparesis and weight loss and how to modify her diet.

It just drives me nuts that the folks writing the health care bill have no experience in what they are talking about. They want to spend millions on walking paths and farmers markets, when the folks that will enjoy them are already predisposed to walk outdoors and buy fresh foods. Those that don't live that way naturally are not suddenly going to see the new park or path and say "Gee, I think I will start walking every day". If you grew up hating vegetables, or your mom never cooked them, a new expensive farmers market is not going to create an epiphany. Please save the tax payers money and re-write the health reform bill to correct what is broken, not try to change human nature.

Specializes in LTC.

I'm 58 years old. We always fed our cows corn. What do you suppose silage is. It's corn stored in a silo for winter feeding. Deer love corn and deer meat, especially tenderloin, is lean and delicious.

Cows are ruminants, they're not supposed to eat corn, they are supposed to eat grass. When cows eat corn their stomachs become increasingly acidic and as a result they produce acid loving E. Coli bacteria that can be passed onto humans. Factory farms treat this in two way: 1) they give the cows antibiotics and 2) they treat the meat with ammonia. And we eat it. Sounds good, huh? Fortunately we are seeing a trend towards the purchase of meat from organic farms.

Are you saying that running throught the drive through is hard work? OMG.

Nope.

Then why has the lifespan improved over the years, the same years that consumption of fast food has skyrocketed. Why was the lifespan lower when all you could get were home grown veggies and home grown poultry, beef, and pork?

You tell me. I'm guessing it's increased in medical technologies. Fifty years ago, if a person had a heart attack they were finished, today that is not the case.

Another interesting observation regarding the not too distant past, we saw a lot less morbidly obese people.

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