What are the most effective, most cost effective methods of health promotion

What are the most effective, cheapest methods of health promotion we have access to in 2005?

Offhand I can think of

Healthy diet
regular exercise
stress reduction techniques (meditation, yoga, etc)
not taking up smoking
developing good interpersonal relationships
being spiritual
getting screened for cancer when it is stage I
vaccinations

Am I missing any?

What’s that got to do with the price of rice? I’m not the least bit spiritual. Not even a little bit. But I’m healthy as a horse; I’ve never even had the flu.

http://kidshealth.org/parent/positive/family/spirituality.html

Then again

http://www.hbns.org/newsrelease/religion3-11-02.cfm

There was a famous study that showed that religious people lived a statistically significant amount of time longer. Of course, correlation is not causation, the most likely mechanism is that people who go to church have more social interaction which leads to a longer life.

I find it ironic that this of all threads is one that google couldn’t find an appropriate ad for,

Well, excercise and good diet can both be money-savers. You can get a fair bit of exercise just by walking or biking places instead of driving, thus saving on gas and some car maintenance. Or bike everywhere, and not have to buy the car in the first place. And the cheapest foods you can get are for the most part fairly healthy, like dried beans and grains. So I’d have to say that both of those are extremely cost-effective. Likewise, not taking up smoking can’t help but be a financial plus, since you’re not paying for cigarettes, although quitting if you’ve already started might cost you for therapy or pharmaceuticals (I have no idea how much these generally cost).

Two question marks in the OP?

You, sir, are not Wesley Clark.

I put question marks in my sentences, just not in my titles. It seems silly to put question marks on the end of your sentences in a forum called ‘general questions’. Its almost like putting exclamation points at the end of all your sentences in a forum called ‘guess what just happened’.

You haven’t defined health. :frowning:
Health is one of those tricky concepts. Everybody knows what it is, but nobody can define it. To understand why this is a problem consider the second item on your list “regular exercise”. It might seem obvious that regular exercise is a cheap way to increase health, but in the youngest age groups particularly exactly the opposite is true. Once we separate out those individuals who can’t easily exercise for pre-existing health reasons (like being in a wheelchair) young people (18-35 IIRC) are significantly more likely to suffer health problems if they exercise regularly. (Don’t ask for a reference for that. I read it in a reputable publication, but I no longer have access to it.)

That might sound screwy, but the reason is quite simple: sports are dangerous. People who indulge in exercise suffer everything from torn muscles and blisters from running, spinal injuries from lifting weights, assault injuries in match fights through to severe head and spinal trauma from falls and crashes. And of course any number of other sports injuries should be obvious. Ask anyone who exercises regularly and they will almost certainly have suffered some sort sporting injury in the last 6 months.

Meanwhile for young people the number of health problems prevented by exercise are actually quite low. Most of the health problems like diabetes and heart disease tend to set in during early middle age. Moroever these health problems tend to be singular. A person has cardiomyopathy or adult onset diabetes. They are ill once, with one condition, albeit chronic. In contrast regular exercise will likely produce several minor acute illnesses every year. So even over a lifetime regular exercise may in fact actually reduce health.

So the answer to the question very much depends on how you define health and how you then measure. If you simply define health as ‘lack of illness or injury” and measure it by how many illnesses/injuries a person suffers in their life then you get some very surprising answers to your question. If you define health in terms of life-threatening/debilitating illness then you get a totally different list.

Then we have to decide when health ceases to be an issue. This might seem obvious too. Health becomes an issue at or shortly before birth and it ends at death. That’s fine, except illness increases with age, especially chronic illlness. So rather ironically the most cost effective way to ensure good health is not to treat any chronic terminal illness. Not only does that mean that a person diagnosed with cardiomypathy at 50 is unlikely to develop glaucoma at 60, it actually has a negative cost. It’s free not to treat these illnesses and die rapidly and expensive to treat them and live a functional life with chronic illness for 30 years.

Taken to extremis if we assume that health encompasses whole-of-lifespan then the single most cost effective way of ensuring good health is to commit suicide as early as possible. If everyone killed themselves as soon as possible they would suffer far, far less illness for the relatively cheap cost of the suicide method.

Now obviously that is not what you are asking. But it does point up the difficulty of ascertaining just what you are asking. How do we say whether getting screened for cancer is really a cheap way of ensuring good health when it has dramatically increased the number of person years spent living with cancer as well as the amount spent on cancer treatments? It is after all cheaper to die of a tumor than it is to treat it.

Another option is to simply discount illnesses contracted in the last X years of life, or after the average lifespan has been reached. That way we can accept that people get ill with age and can measure how healthy they were before illness became inevitable. Or we can measure the number of person years on average saved per dollar for every intervention.

If we look at those things we also get some surprising answers. IIRC wearing a seatbelt (or full face helmet for bikers) is the single most cost effective thing an individual can do to add years to their lives. Because seatbelts are already fitted to most cars by law it’s free to the individual and saves tens of thousands of life-years every single year nationwide. That’s cost effective. We see similar factors for things like home smoke detectors, sunscreen use, child-proof cabinet locks, teaching children to swim and so forth. All either free or less than $10 with the potential to save thousands of person years every year in terms of prevented deaths.

This is where the surprises come from., Things like diet and exercise can ward off potentially fatal chronic illnesses that kill later in life, but there are numerous things that are effectively free that can ward off acutely fatal things like burning to death or drowning.

Then we get to things that are relatively expensive but have almost incalculable benefits. Provision of sewerage to separate drinking water from faeces and treatment of drinking water is fairly expensive, but it has probably saves 90% of the people in every major city and town from severe illness every 12 months. The same for food hygiene standards and so forth. These might seem obvious but they are highly cost effective methods of health promotion.

And of course if we want to cheat by including “not smoking” then we could also include other prohibitions like “Not exceeding the speed limit by more than 10mph”, “not driving tired” “not swimming while drunk” and “Not jumping of tall buildings while on acid”. All those things are far more risky than smoking and just as cheap not to do. But Is spu

I think you really do need to define things a bit more before any answer is possible.

Health would be defined as increased life expectancy, warding off and/or managing chronic disease and lowering healthcare costs.

As far as exercise, I don’t agree totally. Chronic disease can be managed and several of the big killers can be fought with regular exercise. Things like diabetes can be managed with exercise while exercise has been shown to ward off alzheimers, cancer and cardiovascular disease. So even something like a bike ride (which is reasonably safe) for a 60 year old may end up saving them a few thousand a year in prescription medications and surgeries that they would otherwise need.

I was reading I think Time magazine and there was an interview with an 80ish year old man. In his 60s his friend died of CVD and he himself couldn’t afford healthcare so he decided to try to improve his health to improve his life expectancy and lower his medical costs. He took up bike riding to the point where he was getting in about 4,000 miles a year and he eats a diet high in fruits and vegetables. He says even though he is in his 80s he doesn’t have any prescription medications, which is intersting as many people in their 80s take 5-6 medicines that can run $8000 a year or more.

So to me that is a definition of health. He is cutting his healthcare bill, increasing his life expectancy and warding off/controlling chronic illnesses.

And the problem with things like ‘dont take LSD and play with power tools’ as a pro health activity is that is it not effective at promoting health. I was looking for things that are both cost effective and effective in general. Those examples are minor things that will only affect a handful of people while regular exercise can save 300,000 american lives a year, probably several million worldwide. Exercise can also ward off endless diseases and improve mood. Only a handful of a handful will take LSD and do something stupid.

Wearing a condom would probably also count

The problem is that two of those things are in conflict with the other. Increasing life expectancy usually increases chronic illness and healthcare costs. So how do you intend to rate them when they compete? If cancer screening increases the costs of healthcare by increasing biopsies, surgery on benign tumours, delay medication for untreatable cancers etc. how do we weigh that against the number of years added to life expectancy? Is $100 dollars in increased cost equal to one year with chronic illness and 10 years without for example?

And I never suggested that some diseases can’t be treated with diet an exercise. Of course a great many can. The problem is that the majority of illnesses can’t be dealt with in this way. So we still return to the problem of how to weight these things.

If exercise for example can treat or prevent 1000 cases of diabetes (a chronic disease) every year but causes 10, 000 cases of chronic cartilage damage a year then do we say that exercise is a net benefit, or a net expense? Are all chronic conditions equal, or are potentially deadly conditions like diabetes to be weighted higher than a trick knee that twinges in cold weather? And if severe conditions are weighted higher how much higher do we weight them?

We also shouldn’t rely to much on one example. This individual has managed to cut his healthcare bill, increasing his life expectancy and warding off/controlling chronic illnesses. But most people will manage only one or two out of that three. They may have lower healthcare bills and longer healthcare through warning off heart disease, but they also suffer from rheumatism from sports injuries, hearing loss due to dancing to loud music, a slipped disc from lifting weights and have had a toe amputated due to frostbite while skiing. Are these people these people to be rated higher or lower than someone with chronic heart disease/hypertension that costs $300 a week to treat but otherwise is perfectly healthy?

Sorry if I sound like I’m nitpicking here, I’m just trying to work out what we are actually trying to measure.

I’m always amused when I see this type of statement. Nothing has ever saved a single life, ever. The historical death rate up to 1880 has been 100%. IOW everybody who has ever lived is guaranteed to die. No lives have ever been saved.

That’s not a trivial point to make either. Regular exercise can’t save lives, it can only save person years. That’s important when we compare exercise that saves people primarily in late middle-age vs. safety legislation for toys or vaccination that save primarily children. Every child saved represents 70 person years, every 60yo saved by exercise represents 20 person years so exercise needs to be over 3 times as effective as toy safety legislation just to be considered equivalent.

Which again brings us back to our problem of comparatives. Tooth decay is a chronic illness. Once a cavity develops it almost never heals. So is every childhood cavity prevented by not buying soda to be considered equivalent to 3.5 cases of adult onset diabetes prevented by exercise? In which case I suspect that not buying children soda is the single most effective thing we can do.

Moved to IMHO.

-xash
General Questions Moderator

Blake: I’m not an expert in this field but I believe the most commonly accepted metric used is Quality Adjusted Life Years. It’s by it’s nature subjective but it’s better than nothing.

True. Increased life expectancy also increases social security payments.

Cancer screening is designed to avoid more costly treatment. A $200 test can avoid tens of thousands of dollars worth of testing. Regular exercise and a healthy diet can drastically cut the risk of cancer and improve prognosis after a person gets cancer and both are more or less free.

Your examples aren’t making sense. Promoting health simply means increasing life expectancy, creating lives free of chronic/debilitating illness and cutting healthcare costs.

I don’t think that is a good example. There is some news about vaccinations causing autism, but I don’t think the trade off is a 1:1 ratio by any means. Also there are forms of exercise you can practice that are easy on the joints. So that really isn’t a good example as basic preventitive measures can avoid these things.

I doubt a person will get hearing loss from listening to music or a toe amputated from skiing. These are very out of the way examples you are listing and not applicable to most people. And they really don’t have anything to do with the question about what effective and cost effective ways are there to improve health.

No, but it has increased lifespan and put death off by a few years.

The definition of health is to save money on healthcare costs, to promote a life with no/few chronic debilitating diseases and to increase life expectancy.

That doesn’t make any sense. Here is a simple example

http://www.matria.com/resources/clinical/dm/diabetes_summary.html

While the average annual healthcare costs for a person without diabetes is $2,500, the cost for a diabetic is $13,243. One of the most common and expensive chronic conditions, diabetes is costing the nation roughly $132 billion annually.
Type II diabetes can to a large degree be avoided or controlled with exercise and a high fiber diet. If a diabetic engages in healthier lifestyles they arguably could save close to ten thousand dollars a year. One study showed a healthier lifestyle cut the risk of contracting type II diabetes by 58%. So a person who engages in these lifestyles could save themselves or their insurer thousands of dollars in healthcare costs annually and add several years to their lives.

I felt compelled to state that “not taking up smoking” is disingenuous for those of my age bracket and the places I’ve lived.

How about “participation in smoking cessation programs” as well as not starting smoking. And the Cessation is just as hard - if not harder in some cases - as anything else on your list but can have some of the longest term helath benefits of all.

Just something I struggle with daily.

Inky

My examples make perfect sense. Your defintion is self-contradictory. Taking up excercise can create lives with chronic/debilitating illness such as cartilage/tendon damage, back strain and so forth. Those aren’t extreme examples, they are common for those who regularly excercise.

Yes there are. But that isn’t what you said. Herein lies the problem. We now have to separate out “unsafe excercise” from “safe excercise”. So no longer is it simply exercise on our list, it’s specific and very limited exercises. Most of them tend to be water based since even walking/cycling tend to have risks associated with them, not least getting struck by a car. So the cost reltive to benefit of exercise has now increased to the point where I don’t even know if it’s going to be in the top 10.

Exercises that don’t have any dangers of connective tissue or spinal damage are also not applicable to most people.

OK, so it’s only debilitating and chronic disease that we are interested in. Now we’re reaching apoint we can start analysing.

It makes perfect sense. You said you wanted to rate chronic conditions. Dental caries is the single most common chronic health condition in the world. Saying it makes no sense to include the single most common chronic condition on Earth with no reason makes no sense. Now that you have clarified your question to include only illness that is both debilitating and chronic we can exclude it on the grounds that it usually isn’t debilitating, but that sort of clarification was excatly what I was trying to extract with that examples. The example itself makes perfect sense.

This is the type of thing I mentioned above. I’ve seen several similar schemes to that one as well as the other alternatives I discusses above such as cutting off the later years altogether and so forth. There are lots of these available, each with its own critics it seems. Which points up just how hard it ois to get any sort of factual answer ot this sort of question.

I have read that daily flossing is wayyyyy more important to overall health than you would guess. The bacteria buildup that it prevents protect against heart disease and a host of other diseases.

I would guess that washing your hands after going to the toilet and before preparing/eating food is close to no 1.
I seem to recall reading that getting this message across (along with an adequate supply of soap) to everyone in sub-saharan africa alone would prevent millions of cases of sickness every year.