Prevention and disease management

This final category is not normally included with the earlier four, but is increasingly important. It covers specific disease-management programs, such as for diabetes, as well as general wellness initiatives, including employer-supported fitness programs.¹⁸ According to a 1988 Centers for Disease Control and Prevention (CDC) study, “prevention” is defined as health promotion, health protection, and preventive health services. It amounts to more than $30 billion within the United States.¹⁹ The rationale for preventive and disease-management initiatives is simple: The United States spends the most per person on healthcare (more than $6,000 per year), while ranking low among Western nations in terms of longevity, infant mortality, and incidence of obesity and diabetes. Even worse, average annual healthcare cost increases in the United States are among the highest in the world. In an effort to lower costs and improve outcomes, prevention and disease management are receiving more attention in the United States. However, the link between behaviors and health is very complex. Although the data are overwhelming that individual behaviors can greatly impact specific risks (such as smoking and lung cancer), broader indicators such as longevity are not so easily tied to specific behaviors. For example, in Japan, nearly one-third of the population are daily smokers—one of the highest rates in the world—yet its population lives exceptionally long. And the British, who are comparable to Americans in the percentage that is overweight, enjoy a ....