Prevention Nation: When Health Care ‘Takes Over’ The Government

It’s an unsung and little-known piece of Obamacare — even though it is beginning to permeate our government, and it aims to permeate our lives (in a nice, non-Orwellian way, that is) and it may be our best hope for reining in the country’s skyrocketing health costs.

It can be summed up in a word: Prevention. To wit: It is far, far better to keep people healthy than to treat them when sick — especially with our staggering rates of chronic disease, such as this week’s statistics on the soaring rates of diabetes. To that aim, thinking about health has to inform government policy across the board — even in agencies that seem to have nothing to do with it.

You’ve likely heard of the free preventive care, from checkups to vaccines, that Obamacare requires. But this gets even bigger than that. Obamacare expert John McDonough of the Harvard School of Public Health calls the prevention piece one of the most visionary and long-term-important parts of the law.

You think, ‘Oh my God, this is an attempt by the health care people to take over the universe,’ but it’s actually the opposite.

“What’s interesting about it,” he said, “is that it is the first major federal effort at crafting an approach that is referred to as ‘health in all policies,’” an international concept for infusing preventive health into all government policies, from transportation to housing to education.

“If you first look at it, you think, ‘Oh my God, this is an attempt by the health care people to take over the universe,’ but it’s actually the opposite,” he said. “It’s an approach that says that by incorporating a preventive health mindset into all of these other domains, you can dramatically decrease the size and cost of health care in the United States.”

“I think this is the future of how we’re going to fix health care,” he said.

He offered an example: The “Green and Healthy Homes Initiative.” The Department of Energy wants to weatherize the nation’s homes, but in many low-income neighborhoods, sealing in the heat also seals in triggers of asthma, lead poisoning and high blood pressure. So if the unhealthy factors are fixed at the same time, you lower not only energy costs but medical costs. “The health people, housing people and energy people working together: That’s a ‘health in all policies’ approach,” he said. “That’s what the national prevention strategy is all about.”

If this country did royalty and we had a Queen of Prevention, that would be Dr. Regina Benjamin, the surgeon general of the United States and thus “America’s doctor.” (No, it’s not Mehmet Oz.) She leads the new National Prevention Council created under Obamacare, and was recently in Boston to receive an award from the health policy institute NEHI. Our conversation, lightly cut and edited:

Dr. Benjamin: The National Prevention Council is made up of 17 cabinet-level members, who are all focusing on prevention. The Department of Health and Human Services secretary, the secretary of education, secretary of housing and urban development, the VA, transportation, the USDA. All these cabinet-level members are sitting around the table now, looking at health and wellness from a prevention standpoint, and this is the first time ever.

The council released the first-ever national prevention strategy and the goal of the strategy is to increase the number of Americans who are healthy at every stage of life, whether you are two or 92. We want you to be healthy and our mission is to move our health care system from a focus on sickness and disease to a focus on wellness and prevention. With this national prevention strategy we’re engaging all parts of our society, everyone from individuals to companies to government to local governments, churches, community and faith-based organizations.

If Obama had lost and the Affordable Care Act had been repealed, would this not have been going forward?

I believe that the prevention movement will go forward, because it’s common sense. If we can prevent you from getting sick in the first place, we’re better off.

I think it would go forward, but it’s easier to go forward with a strategy, a foundation in place. The strategy is really the vision, a roadmap, on how to become a more healthy and fit nation. We basically can do what we can with the federal government — we want to set an example for the rest of America, for the cities and states. Others are starting to adopt the strategy, and that’s what our goal is.

So paint me a picture: If a child born today benefits from everything you’re planning — how would their life look different?

Health isn’t something you think about once a year when you go to the doctor. It’s in everything.

The first thing: They’d be happy. They’d be enjoying being healthy, and they would look at health as fun and as enjoyable, and not as a burden or something you have to think about. It’s something that you are. It’s something that’s part of you, so health and wellness is in everything that we do: It’s in where we live, where we learn, where we work, where we play, where we pray. It’s in everything. And so health isn’t something you think about once a year when you go to the doctor. It’s in everything. And so that kid would just grow up with that healthy environment, with that healthy outlook on life.

So what would that look like?

They would be eating healthy foods that taste good, not just ones that taste pretty rough. They’d be playing and dancing and flying kites, riding bicycles, walking, enjoying being physically active as part of their everyday lives. And having good relationships with friends and family and parents, as part of a healthy community.

You’re so positive, but let’s get a little negative, because to promote health, the big battle is to counteract the commercial influences that have gotten us where we are today.

It’s hard for me to be negative, because I think it’s important that we be positive. And when it comes to commercializations involving corporations and industry, they need to be part of the solution. So just telling them how bad they are is not going to do that. They know how bad they are. I don’t have to be the one to tell them.

But what I can do, they have expertise that can help us find solutions. Most of these companies are in business to make a profit and if we as customers and consumers want healthy products, they’re going to provide those healthy products. The idea is to make them part of the solution so they can create some of those healthier options. They’re part of the community as well.

When I think about the tasks involved in prevention, particularly in terms of obesity and eating, and I think about it from an individual level, I just think it’s so very hard. It’s so hard to get yourself to work out and to get yourself to eat right. So what can the federal government really do to make me make the right decisions on those things?

It can be hard but it doesn’t have to be hard. The choices right now are pretty hard. We have to make the healthy choices those easy choices. So for example, if you go into a convenience store, it’s hard to find healthy things there. We can put healthy things there to make it easier.

U.S. Surgeon General Regina Benjamin

To walk — it’s oftentimes not easy to find safe walking spaces and places to ride your bike. We in the federal government can make those routes and make it easier to make those choices easier. It’s still your choice, but it’s easier to make those choices.

So that’s what the Department of Transportation can do?

One thing transportation is doing is they have a program on safe routes to school, called ‘Walking Schoolbus” — parents pick up kids and walk them to school. Housing and Urban Development are making their low-income housing units tobacco-free — and not just the unit but the entire building is tobacco-free, and they have people on their waiting lists that want to be in a tobacco-free building. And the USDA has the My Plate program.

The Department of Defense is doing a number of things within the military, making the military bases and hospitals baby-friendly, tobacco-free programs on bases. They have something for food I call traffic lights — red, green and yellow symbols so the soldiers can easily know what they’re eating and make better choices.

Just to be the skeptic, these all sound wonderful but I feel like they’re tiny drops in the bucket against the obesity epidemic that’s been sweeping our nation…

We didn’t get here overnight. It took us time. And over time we got here. We have bad habits. and to change habits takes time and it takes little movements, little things that make those changes, that begin to add up.

No one likes to be told what to do. So if you told me I could never have ice cream again, then even as a child you’re going to rebel. Se we start doing small things, make those small changes, and we can move toward a more healthy society.

Everyone knows we should exercise, eat healthy, not smoke. Anything you think people might not know?

Mental health is just as important — so trying to decrease the stress in your life, taking time to relax, that’s very important to your overall wellbeing. Getting enough sleep — we don’t think about how important sleep is, and as you start to get more sleep, it really changes how you feel every day, how you function. And drinking more water — most of us don’t get enough water.

So overall, is prevention gaining a level of federal attention or commitment it’s never had before?

Thanks to the Affordable Care or Obamacare, we are now looking at health with the goal of prevention, of changing our health care system from one based on sickness and dsease to one based on health and wellness and prevention. And that is common sense, that we can do it. It’s not money that we need to do that, it’s just our own mindsets, our own will to be healthy. That’s a different mindset for individuals but it’s one that I think can be fun and can be enjoyable.

And so I have this idea of a ‘journey to joy.’ When we talk about health and wellness, when we talk about obesity, we should be positive and I hope people will find their own health care joy, and their own joy in being healthy.

What brings you joy in health might be different from me. One person might want to run a marathon. Another person may want to just fit into an old pair of jeans. Yet another person may simply want to be able to sit up all afternoon to be able to play with their grandkids. Whatever your personal joy is, you find that joy and our role in government is to help you get there.

So we’re talking about a cross-agency government commitment to wellness that is unprecedented?

It is unprecedented.

We’re trying to be innovative and find new ways to reach people. We can’t just write a report and put it on a shelf. So with our walking and exercising and fun things we’re doing, like dancing and Zumba, we try to involve people. Everywhere I go, to towns and events, we try to have a walk or some kind of activity.

So Zumba’s part of your job now?

Whatever the community wants to do — we’re trying to reach people where they are.

Everything you say makes total sense, but you’re also constrained by politics. If you were queen and had no constraints, what would you do that you can’t do now?

I don’t see barriers. I see opportunities. And so i think it’s really important that we give people the will to want to do it. We don’t want government telling us we’re having fun. We want to have fun on our own.

Readers? If this is the nanny state, I’d say it’s Mary Poppins. What do you think?

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  • trena

    People who feel threatened by preventative health care, and by gov’t. regulations to protect and expand preventative health measures, are irrational in the same way that a drowning person, when being rescued, fitghts the rescuer.

  • Avery

    Great segment. Preventive medicine is exactly why for-profit, private heath insurance and pharmaceutical corporations cannot solve the health care problems of today and tomorrow: they have no economic incentive to push for preventive care, only for palliative care. While we, as a nation, have a big economic incentive to use preventive medicine. Government is the solution. It’s not a dirty word. Government is another way of saying ‘you and me.’ And I echo the comment of David Fragale: it’s ACA, not ‘Obamacare.’ Every time that word is mentioned it implicitly supports a xenophobic and divisive agenda. Thanks, WBUR.

  • Dr CD Tauber

    Why does Dr. Benjamin have to wear a military uniform. As a physician myself, it seems to me that a military status violates the very principle of saving lives rather than destroying them.

    • Robert D Bruce

      Dr. Benjamin is the Surgeon General and as such is in charge of the officers of the Commissioned Corps of the U.S. Public Health Service; one of the SEVEN (7) uniformed services of the Nation (the others being the familiar U.S. Army, U.S. Navy, U. S. AirForce, U.S. Marines, U.S. Coast Guard and the less familiar NOAA Corps). The U.S. Public Health Service is the only uniformed service dedicated to public health and has about 6700 active duty officers (
      Those officers serving underserved and vulnerable populations throughout the Nation would likely strongly disagree with your assertion that serving in uniform equates to anything BUT saving lives. Those servicemen and women who have been laboring 24/7 alongside the U.S. Public Health Service aiding those impacted by Hurricane Sandy would be equally vocal in their dissent to your assertions, I believe.

  • trena

    This is all about a very exciting trend! It makes such perfect sense. I don’t see, can’t imagine, how anyone in the world could object to any of this.

  • Bill

    The surgeon general, the face of American health, reflects the fundamental problem:
    she is fat. She is not the correct weight for her height. She is fat! Fat! Fat!

    She is a Fatty!

    Yes! The surgeon general of America is a fatty.

    • kansasnik

      Such childish drivel. And obvious ignorance. Current science has proven that health status and weight are related, but not necessarily inter-changeable. A person can be bone thin and unhealthy, or carry extra pounds and have a clean bill. You don’t know any of her medical data or life style habits. You are judging on appearance and not fact. Back off, Bill.

    • Miss M

      You’re comment would be a lot more valid if you posted a picture of yourself so that we could bask in your natural beauty. I’m sure you’ll be able to do that after you’ve finished with your GQ cover shoot.

  • gerardo gala

    She doesn’t look physically fit to be leading the country to a healthy lifestyle. What is her credentials? Does she even belong to a gym? How many push-ups can she do? Does she cook her own meal? Does she grow her own vegetables? Does she support the farmers’ market? How often does go to a fast-food restaurant?

    • kansasnik

      Her credentials to serve as the Surgeon General of the United States obviously include being a physician and the ability to use correct grammar (the last of which your lack, obviously). Your questions are silly. Do you ask your personal doctors these questions?

  • AdamsQJohn

    Yeah, yeah…enough with the flowery words, already. I’ve only been hearing this fluff for about 20-30 years now. They talk, talk, talk, and never act. It’s criminal, actually; and way, way past time for the American government and the rest of our for-profit-mongering-health-care system to


  • JEngdahlJ

    Current utilization of preventive services is about 60-70% of what is clinically
    suggested in PPACA.

  • oregon trail

    Big government telling us what to do again! Your healthy leftist lifestyles have put hostess out of business. Being morbidly obeast shows the world that America is a prosperous country. This healthy eating will put us on a slippery slope to anorexia and Bohemia just like those starving people in Africa.

  • bluewidow

    sadly there is no restraint on price hikes.. the current monopoly formed by mergermania, and the control big insurance has over hospitals, clinics and other care facilites, I estimate they, will soon dictate to government…. after all, adjusters have blanket immunity in work compensation cases…even if they delay care till the claimant is dead or incureably crippled for life. Now the question is how to make this brutally cruel industry to behave… they never get prosecuted when they harm or fraud people.

  • Joe B

    Keeping a positive perspective, sure, but I would like to see more details of what this looks like. How do they expect to “give people the will to want to do it”?

  • Sensiblevoice108

    Universal health as a basic concept is ret. However the delivery mechanism is flawed. The responsibility to provide coverage is largely on the employers. Think for a minute the contrast between two companies. Company 1 employs 70 people and is having a revenue of $100 million and company 2 who is a home care agency who employs 70 people and has a revenue of $2 million in a year

    The cost of Obama care for both the companies would be around $600k for both companies. While company 1 may be able to afford it, company 2 would go bankrupt if they have to provide health benefits.

    The second aspect is that the high cost of care is the reason why most Americans do not have health ca since it is not affordable. There has been no effort at addressing to control the cost of care. In other countries, for the cost of doing a root canal in US, we can get a heart bypass done. Same drugs manufactured by the same company cost about ten times more in US than in other countries. Such issues are not addressed.

    It is a mystery when it is called “affordable care”. Affordable to whom?

  • Random Thoughts

    Can it now be honestly said that an individual’s personal habits are no longer his or her’s business but now the government’s business?
    “it aims to permeate our lives (in a nice, non-Orwellian way, that is)”
    —- so says government sponsored media.
    Are we all “Julia” now who along with being a character from the Obama campaign in 2012 was also an Orwellian character in “1984″.

    • OM

      Unbelievable how ridiculous the right wing has become. Good thing we already established laws against murder, rape and theft, otherwise you would have considered it a “government take over of ethics”.

      How do you turn a statement about people finding joy, happiness and health into government taking over your life? They are not taking over anything, just giving opportunities to the ones who care!

      You would rather have 50% rates of obesity, hypertension and diabetes than hearing a government representative talking to you about health and prevention?

      What ever happened to people?

      • Josh

        I think that people can find this “search for health” on their own without constructing a government program that is the equivalent of a gentle push in the directions of the carrot sticks and away from the chocolate cake.

        People do what they want to do. You can attempt to influence them all you like, but what’s the cost/benefit? Funding public health care is a government cost that is dictated almost wholly by personal decisions on your own health. It’s the Sisyphus of public policy. You say would you rather have “50% rates” or “hear a gov rep talk about health and prevention”? Like these are mutually exclusive events? Hardly.

        My guess? We will continue to have health issues and the government will create a nice robust department which will “fight the good fight” and consume an increasing amount of government budget in the process, while practically changing very little. Sort of like the DEA. The government thrives at making careers out of fruitless endeavors.

        Mary Poppins was never this deluded.

  • David Fragale

    Carey Goldberg, in the first sentence of this article you use the term “Obamacare” as opposed to “the Affordable Care act” or ACA, the actual name & abbreviation of the bill. I hope in the future you will try to be more accurate.

    • babby660

      Personally, I LIKE Obamacare — I also like that it originally was intended as a putdown, but the tables have been turned — Ha. I am disappointed that it’s not a single payer plan, but now that it’s the law, maybe we can tweak it to become one.

  • Genie

    What a good article! Good for the heart – in more ways than one!

  • Doris

    Sometimes we need a nanny to tell us what is good for us…. Thank you Dr Benjamin for your upbeat and positive comments on how we can change our habits and by extension our lives. I like the idea of this joyful approach to a healthier existence and environment. Let’s all share the joy – and together reap the benefits of a more worry-free and hale life for ourselves and our planet.

  • Elizabeth

    I listened to the comments of Dr. Benjamin and the way she started out is what interested me. It is clear that prevention is worth far more than people attach to it. Our current system is focused on sick care and not prevention and needs to adopt more preventive health care measures beginning with education. We are ultimately responsible for our own state of health or sickness and we need to learn how to properly take cre of our bodies. We only get one shot at getting it right, and not getting it right is very costly to everyone. I can’t encourage people enough to look into holistic health and learn what your need to know it improve your health utilizing your physician as a partner rather than a god who knows all. My last point of encouragement is to leave politics out of wellness care all together. Thank you, Elizabeth

  • isarose

    Michelle Obama has already taken the bully pulpit with food companies and all that salt and sugar. It is going to be tough. We can help by standing taller and louder in our homes and schools about our desires for healthier foods. They have gotten more fresh foods into school lunch, for example. We can’t just sit and fret about optimism and pessimism; we have a job to do.

  • Laur

    Let’s start that healthy road with healthier processed foods. Cut down on all the salt and artificial ingredients in today’s prepared foods!

  • Liz Malone Gerron

    I like the concept of instilling preventive strategies across a broad base social areas, but I think she avoided a lot of the tough questions by simply saying she “wants to be positive” or “doesn’t see barriers.” Optimism is not a strategy. I would like to hear more about specific plans–particularly with regard to how healthy food becomes easily accessible and affordable to the poor. Ideas are great — she glossed over the implementation.