Making the Case for Prevention: A Q&A with James Marks of RWJF
James S. Marks, MD, Senior Vice President of the Robert Wood Johnson Foundation, recently spoke on a keynote panel at the annual ASTHO meeting in Austin, Texas, on making the case for prevention. NewPublicHealth spoke with Dr. Marks about the great potential for investing in prevention.
NewPublicHealth: What do you think are the big issues facing state health officers across the country?
James Marks: The thing that I am most struck by is that we all know that public health, like so many of our sectors, is struggling in these tough economic times. But I’m seeing state health officers look increasingly at how they and medical care can connect and integrate and support each other as something we need increasingly in this country. They have to ask where they are going to get the best value in health. Sometimes it will be in medical care, many times it will be in prevention and public health, and they should be working to create common purpose.
NPH: What is the training of health officers for that?
James Marks: It varies. They come from a lot of different backgrounds. Some have purely clinical training; some of them have long standing public health backgrounds; and some have had a lot of analytic experience or even economic, policy or business experience. Very few have had all of these, and so coming to a meeting like this is about learning as well as recognizing that they’re all starting to move in similar directions and to get ideas from each other on how to do that.
NPH: What is your key message to the state health officers?
James Marks: I’ll be speaking about making the case for prevention, and will say that the science has gotten ever stronger and the outcomes clearer on the value of prevention. But my main point is going to be that prevention–or keeping people from getting sick in the first place, is crucial for business and that we are seeing mayors and governors around the nation recognize that having a healthy population, a healthy community and state, is attractive to business. The job of those political leaders is to help ensure and promote a good economic climate, so they have to embrace prevention too.
NPH: Prevention takes some investment. Is it worth the cost?
James Marks: Asking “does it save money” puts an unfair burden on prevention. People don’t spend money on health care because it saves money. They spend it because they want good health. So we should say, let’s have a level playing field on what gives us good value. Many things cost money but they give us a lot of good health. Some things in clinical care save money and some things in both prevention and treatment may be just too costly.
NPH: Can prevention help reduce health care costs?
James Marks: That’s where the evidence is getting stronger and more compelling. The place that I find it the most compelling is where we have a little bit longer history — in tobacco. There are other areas that are well-known such as immunizations. But in California, in the last 15 years they have seen an incredible increase in health care savings. Studies show they have saved fifty dollars for every dollar spent, and are up to $56 billion in health care costs saved. That’s a tremendous return on investment, and it happens in a quicker time frame than most people realize. The return on investment is because the health gains are great in areas such as cancer and heart disease. An area where we don’t have quite as much data as we wish we did is diabetes, but even there we’re starting to see that data accumulate.
NPH: What key question do policy-makers ask about prevention?
James Marks: From my experience, they ask: “Are we sure we’ll get value from prevention?” I respond in two ways: I don’t think they always realize how big the benefit is, and they are concerned it will take too long. So finding the elements of prevention that pay off very quickly are very important for them, as well as having policy-makers realize that it can work in their state or community. And then when they get that, they look for ways to have it happen.
For example, people think tobacco prevention takes too long but really you get return relatively fast because of the fact that heart attacks will fall immediately. Immunization pays off right away. And, if you give people who are pre-diabetic counseling on weight loss and exercise, they can cut their risk of diabetes by 60 percent within five years.
NPH: Many federal agencies are already engaged in working on the National Prevention Strategy. Who else do we need at the table to help reduce the disease burden in the United States?
James Marks: Business. They are increasingly at the table when the health of communities is being discussed, and their influence will raise the urgency for the federal agencies and state and local health departments to act. Business pays for health care. Health care is a cost. Good health is an investment, and a base on which you can build a successful business. We know business looks at the healthiness of a community before they invest there. They are looking at the obesity rate — because they see that as a proxy for future health care costs. IBM, for example, opened a plant in Dubuque, Iowa, because the health care costs there were the lowest in the nation. A plant opened recently in Allentown, Pa., where the location was chosen because of the health of the community.
The County Health Rankings (a program of the Robert Wood Johnson Foundation and the University of Wisconsin) makes it clear to everyone that there are large differences in health outcomes and quality of life between geographic areas and there is no reason those differences need to exist. The rankings make it clear that many things—such as education, housing and family and social support—determine how healthy we are. It’s not just medical care.
Business is seeing health as one of the factors to consider. So if you’re a mayor or governor your job is to bring jobs to your community, so you look at whether you have the infrastructure, good schools and, increasingly, they’re asking “Do we have a healthy community to help attract business?” And businesses that move to a community that has a lower tobacco rate and lower obesity rate, will find that their employees and their families will be healthier and that’s important for their bottom line.
NPH: Are you seeing a greater sense of cooperation between public health and business?
James Marks: The public health community should celebrate when businesses make decisions that are good for health and appropriately hold them accountable when their actions are not good for health. But in the long run, public health should recognize and understand what motivates all kinds of businesses and business leaders. I think there are more and more opportunities for businesses and public health to find shared purpose. Disney, for example, says it won’t market unhealthy foods to children. That’s good for their business and for increasing their market share among health-conscious families, but it also has great public health value. I hope to see more opportunities for the health and business communities to work together.