U.S. Needs Primary Prevention, Especially for the Poor and Underserved

Aug 14, 2013, 9:00 AM, Posted by

Adrian L. Ware, MSc, is a third-year graduate student in public health at Meharry Medical College. He holds a BSc in biology from Alabama Agricultural and Mechanical University, and an MSc in biology and alternative medicine from Alabama Agricultural and Mechanical University. He is a Health Policy Scholar at the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College.  He aspires to become a Christian psychiatrist serving the poor and underserved. Read all the blog posts in this series.


With innovation, brilliance, passion, and robust planning, public health students and practitioners ask: How can we protect the health of the nation? According to the Centers for Disease Control and Prevention, seven out of ten deaths in the United States are caused by chronic disease. The need for more cost-effective, comprehensive care has never been greater. Within the world of public health, there are three levels of prevention: primary, secondary, and tertiary.


Primary prevention reduces both the incidence and prevalence of a disease, because the focus is on preventing the disease before it develops. This can change the health of the nation for the better. Secondary and tertiary prevention are also significant.

It is well known that emergency care is vastly important, given the sheer complexity of episodic clinical cases that present to the emergency room in “life or death” situations. These “provisions” are necessary for the United States to uphold its high ideals of liberty and justice for all. Adequate, culturally competent, comprehensive health care for all citizens is a social justice issue, and a fundamental right. To this point, our health system’s extreme emphasis on tertiary care is amongst the most fiscally irresponsible ways to improve the health of the nation.

This is in no way an indictment of emergency care; we need it, and we need it in a “critical” way. However, health care expenditures should be much more generous toward primary prevention measures. It is a grievous day when in 2013 the country has to “debate” the efficacy and validity of a mandate for coverage that can facilitate more cost-effective, comprehensive care. For a long time, public health practitioners have expressed the need for a paradigm shift in the way we address health care in this great country.

Unfortunately, partisan politics is an ongoing and deeply rooted source in this debate. Why is this fundamental right even a debate, anyway?  Does it seem like political parties will just oppose any legislation offered by the other party, no matter how beneficial the legislation could be for the majority of Americans?  

This debate in 2013 also highlights attitudes concerning the sheer cost of providing comprehensive care. Policy-makers often reject even the mention of resource allocation strategies that potentially create more primary prevention interventions. Yes, it’s expensive, but primary prevention interventions can save our country trillions of dollars in the long run. Indeed, this is a health policy issue that needs all hands on deck to address these important challenges.

One of the greatest hallmarks of public health is the reliance on multi-disciplinary teams. Medical doctors, political scientists, basic scientists, policy-makers, sociologists, nurses, biostatisticians, epidemiologists, economists, pharmacists, and attorneys all represent a very short list of potential public health practitioners needed to address this important topic.

I believe a healthier America can result from the following strategies:

  1. An increase in the allocation of resources toward more primary prevention interventions.
  2. All hands on deck are needed to address this issue. Long gone are the days of “that’s not my area of expertise.” We need everyone at the table to discuss solutions and identify best practices!  
  3. Medical providers must go beyond the treatment of symptoms. They must address the root causes of disease, by paying close attention to the associated social determinants of health.

In conclusion, I must hopefully note, the implementation of the Patient Protection and Affordable Care Act will play a significant role in ensuring that health care is a right, not a privilege. Health care coverage is the fiduciary responsibility of a country to its citizens, and should be provided, first through primary prevention modalities, most especially to the poor and underserved.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.