Preventive healthcare#Sexually transmitted infections

Preventive healthcare strategies are described as taking place at the primal, primary,Goldston, S. E. (Ed.). (1987). Concepts of primary prevention: A framework for program development. Sacramento, California Department of Mental Health secondary, and tertiary prevention levels.

Although advocated as preventive medicine in the early twentieth century by Sara Josephine Baker,Baker, Sara Josephine. Fighting for Life.1939. in the 1940s, Hugh R. Leavell and E. Gurney Clark coined the term primary prevention. They worked at the Harvard and Columbia University Schools of Public Health, respectively, and later expanded the levels to include secondary and tertiary prevention. Goldston (1987) notes that these levels might be better described as "prevention, treatment, and rehabilitation", although the terms primary, secondary, and tertiary prevention are still in use today. The concept of primal prevention has been created much more recently, in relation to the new developments in molecular biology over the last fifty years,Darnell, James, RNA, Life's Indispensable Molecule, Cold Spring Harbor Laboratory Press, 2011 more particularly in epigenetics, which point to the paramount importance of environmental conditions, both physical and affective, on the organism during its fetal and newborn life, or so-called primal period of life.

{{See also|Parent education program}}

Primal prevention is health promotion par excellence.{{cite web | title = Primal Prevention | url = http://www.primalprevention.org}} New knowledge in molecular biology, in particular epigenetics, points to how much affective as well as physical environment during fetal and newborn life may determine adult health.Perry, Bruce D, Maltreated Children: Experience, Brain Development and the Next Generation, Norton Professional Books, 1996{{cite journal | vauthors = Gluckman PD, Hanson MA, Cooper C, Thornburg KL | title = Effect of in utero and early-life conditions on adult health and disease | journal = The New England Journal of Medicine | volume = 359 | issue = 1 | pages = 61–73 | date = July 2008 | pmid = 18596274 | pmc = 3923653 | doi = 10.1056/NEJMra0708473 }}Scherrer et al., Systemic and Pulmonary Vascular Dysfunction in Children Conceived by Assisted Reproductive Technologies, Swiss Cardiovascular Center, Bern, CH; Facultad de Ciencias, Departamento de Biologia, Tarapaca, Arica, Chile: Hirslander Group, Lausanne, CH; Botnar Center for Extreme Medicine and Department of Internal Medicine, CHUV, Lausanne, CH, and Centre de Procréation Médicalement Assistée, Lausanne, CH, 2012{{cite journal | vauthors = Gollwitzer ES, Marsland BJ | title = Impact of Early-Life Exposures on Immune Maturation and Susceptibility to Disease | journal = Trends in Immunology | volume = 36 | issue = 11 | pages = 684–696 | date = November 2015 | pmid = 26497259 | doi = 10.1016/j.it.2015.09.009 }} This way of promoting health consists mainly in providing future parents with pertinent, unbiased information on primal health and supporting them during their child's primal period of life (i.e., "from conception to first anniversary" according to definition by the Primal Health Research Centre, London). This includes adequate parental leave, ideally for both parents, with kin caregiving and financial help where needed.Garcia, Patricia, Why Silicon Valley's Paid Leave Policies Need to Go Viral, Vogue, culture, opinion, 2015

Primordial prevention refers to all measures designed to prevent the development of risk factors in the first place, early in life, and even preconception, as Ruth A. Etzel has described it "all population-level actions and measures that inhibit the emergence and establishment of adverse environmental, economic, and social conditions". This could be reducing air pollution{{cite journal | vauthors = Etzel RA | title = Children׳s Environmental Health-The Role of Primordial Prevention | journal = Current Problems in Pediatric and Adolescent Health Care | volume = 46 | issue = 6 | pages = 202–4 | date = June 2016 | pmid = 26803401 | doi = 10.1016/j.cppeds.2015.12.008 | url = https://doi.org/10.1016/j.cppeds.2015.12.008 }} or prohibiting endocrine-disrupting chemicals in food-handling equipment and food contact materials.{{cite journal | vauthors = Etzel RA | title = Is the Environment Associated With Preterm Birth? | journal = JAMA Network Open | volume = 3 | issue = 4 | pages = e202239 | date = April 2020 | pmid = 32259261 | doi = 10.1001/jamanetworkopen.2020.2239 | s2cid = 215405527 | doi-access = free }}

Primary prevention consists of traditional health promotion and "specific protection". Health promotion activities include prevention strategies such as health education and lifestyle medicine, and are current, non-clinical life choices such as eating nutritious meals and exercising often, that prevent lifestyle-related medical conditions, improve the quality of life, and create a sense of overall well-being.{{cite book | veditors = Mechanick JI, Kushner RF |year=2016 |title=Lifestyle Medicine: A Manual for Clinical Practice |chapter=The Importance of Healthy Living and Defining Lifestyle Medicine |chapter-url=https://books.google.com/books?id=7gPNCwAAQBAJ&pg=PA9 |location=Cham, Switzerland |publisher=Springer Nature |pages=9–15 |doi=10.1007/978-3-319-24687-1 |isbn=978-3-319-24685-7|s2cid=29205050 }} Preventing disease and creating overall well-being prolongs life expectancy. Health-promotional activities do not target a specific disease or condition but rather promote health and well-being on a very general level. On the other hand, specific protection targets a type or group of diseases and complements the goals of health promotion.

Food is the most basic tool in preventive health care. Poor nutrition is linked to various chronic illnesses. Because of this, having a healthy diet and proper nutrition can be used to prevent illnesses.{{Cite web |date=July 2015 |title=Food is Prevention: The Case for Integrating Food and Nutrition Interventions into Healthcare |url=https://chlpi.org/wp-content/uploads/2013/12/Food-is-Prevention-Report-July-2015.pdf |access-date=May 13, 2024 |website=Center for Health Law and Policy Innovation}}

The 2011 National Health Interview Survey performed by the Centers for Disease Control was the first national survey to include questions about ability to pay for food. Difficulty with paying for food, medicine, or both is a problem facing 1 out of 3 Americans. If better food options were available through food banks, soup kitchens, and other resources for low-income people, obesity and the chronic conditions that come along with it would be better controlled.{{cite web| vauthors = Marucs E |title=Access to Good Food as Preventive Medicine|url=https://www.theatlantic.com/health/archive/2014/04/access-to-good-food-as-preventive-medicine/360049|website=The Atlantic|publisher=Atlantic Media Company|access-date=11 April 2015|date=2014-04-07}} A food desert is an area with restricted access to healthy foods due to a lack of supermarkets within a reasonable distance. These are often low-income neighborhoods with the majority of residents lacking transportation.{{cite web|title=Food Deserts|url=http://www.foodispower.org/food-deserts|website=Food is Power.org|access-date=11 April 2015}} There have been several grassroots movements since 1995 to encourage urban gardening, using vacant lots to grow food cultivated by local residents.{{cite web|title=GreenThumb|url= http://www.greenthumbnyc.org|website=NYC Parks|access-date=11 April 2015}} Mobile fresh markets are another resource for residents in a "food desert", which are specially outfitted buses bringing affordable fresh fruits and vegetables to low-income neighborhoods.{{cite web|title=It's a Market on a Bus|url=http://www.wilder.org/Programs-Services/tcmm/Pages/default.aspx|website=Twin Cities Mobile Market|access-date=11 April 2015|archive-url=https://web.archive.org/web/20151120001336/http://www.wilder.org/Programs-Services/tcmm/Pages/default.aspx|archive-date=20 November 2015|url-status=dead}}

It has been proposed that healthy longevity diets are included in standard healthcare as switching from a "typical Western diet" could often extend life by a decade.{{cite journal |last1=Longo |first1=Valter D. |last2=Anderson |first2=Rozalyn M. |title=Nutrition, longevity and disease: From molecular mechanisms to interventions |journal=Cell |date=28 April 2022 |volume=185 |issue=9 |pages=1455–1470 |doi=10.1016/j.cell.2022.04.002 |pmid=35487190 |pmc=9089818 |language=English |issn=0092-8674}}

{{See also|Screening (medicine)|Biomarker (medicine)}}

Specific protective measures such as water purification, sewage treatment, and the development of personal hygienic routines, such as regular hand-washing, safe sex to prevent sexually transmitted infections, became mainstream upon the discovery of infectious disease agents and have decreased the rates of communicable diseases which are spread in unsanitary conditions.

Scientific advancements in genetics have contributed to the knowledge of hereditary diseases and have facilitated progress in specific protective measures in individuals who are carriers of a disease gene or have an increased predisposition to a specific disease. Genetic testing has allowed physicians to make quicker and more accurate diagnoses and has allowed for tailored treatments or personalized medicine.

Food safety has a significant impact on human health and food quality monitoring has increased.{{cite journal |last1=Fan |first1=Sue-Yuan |last2=Khuntia |first2=Sucharita |last3=Ahn |first3=Christine Heera |last4=Zhang |first4=Bing |last5=Tai |first5=Li-Chia |title=Electrochemical Devices to Monitor Ionic Analytes for Healthcare and Industrial Applications |journal=Chemosensors |date=January 2022 |volume=10 |issue=1 |pages=22 |doi=10.3390/chemosensors10010022 |language=en |issn=2227-9040|doi-access=free }}

Water, including drinking water, is also monitored in many cases for securing health. There also is some monitoring of air pollution. In many cases, environmental standards such as via maximum pollution levels, regulation of chemicals, occupational hygiene requirements or consumer protection regulations establish some protection in combination with the monitoring.{{citation needed|date=June 2022}}

Preventive measures like vaccines and medical screenings are also important.{{Cite book|title=Infection Prevention and Control Guidelines for Anesthesia Care|year=2015 |pages=3–25 | publisher = American Association of Nurse Anesthesiology | location = Park Ridge, Illinois | url = https://www.aana.com/docs/default-source/practice-aana-com-web-documents-(all)/professional-practice-manual/infection-prevention-and-control-guidelines-for-anesthesia-care.pdf?sfvrsn=850049b1_4 }} Using PPE properly and getting the recommended vaccines and screenings can help decrease the spread of respiratory diseases, protecting the healthcare workers as well as their patients.

Secondary prevention deals with latent diseases and attempts to prevent an asymptomatic disease from progressing to symptomatic disease. Certain diseases can be classified as primary or secondary. This depends on definitions of what constitutes a disease, though, in general, primary prevention addresses the root cause of a disease or injury whereas secondary prevention aims to detect and treat a disease early on.{{cite web | title = Skin Cancer Module: Practice Exercises | work = U.S. Centers for Disease Control and Prevention |url = https://www.cdc.gov/excite/skincancer/mod13.htm | archive-url = https://web.archive.org/web/20120222170737/https://www.cdc.gov/excite/skincancer/mod13.htm | archive-date = 22 February 2012 }} Secondary prevention consists of "early diagnosis and prompt treatment" to contain the disease and prevent its spread to other individuals, and "disability limitation" to prevent potential future complications and disabilities from the disease. Early diagnosis and prompt treatment for a syphilis patient would include a course of antibiotics to destroy the pathogen and screening and treatment of any infants born to syphilitic mothers. Disability limitation for syphilitic patients includes continued check-ups on the heart, cerebrospinal fluid, and central nervous system of patients to curb any damaging effects such as blindness or paralysis.

Finally, tertiary prevention attempts to reduce the damage caused by symptomatic disease by focusing on mental, physical, and social rehabilitation. Unlike secondary prevention, which aims to prevent disability, the objective of tertiary prevention is to maximize the remaining capabilities and functions of an already disabled patient. Goals of tertiary prevention include: preventing pain and damage, halting progression and complications from disease, and restoring the health and functions of the individuals affected by disease. For syphilitic patients, rehabilitation includes measures to prevent complete disability from the disease, such as implementing work-place adjustments for the blind and paralyzed or providing counseling to restore normal daily functions to the greatest extent possible.

The general use of machinery that has adequate ventilation and airflow is suggested for these patients in order to halt progression and complications of disease. A study conducted in nursing homes to prevent diseases concluded that the use of evaporative humidifiers to maintain the indoor humidity within the range 40–60% can reduce respiratory risk. Certain diseases thrive in different humidities, so the use of the humidifiers can help kill the particles of diseases.{{cite journal | vauthors = Obara S | title = Anesthesiologist behavior and anesthesia machine use in the operating room during the COVID-19 pandemic: awareness and changes to cope with the risk of infection transmission | journal = Journal of Anesthesia | volume = 35 | issue = 3 | pages = 351–355 | date = June 2021 | pmid = 32856167 | pmc = 7453066 | doi = 10.1007/s00540-020-02846-z }}{{cite journal | vauthors = Bowdle A, Jelacic S, Shishido S, Munoz-Price LS | title = Infection Prevention Precautions for Routine Anesthesia Care During the SARS-CoV-2 Pandemic | journal = Anesthesia and Analgesia | volume = 131 | issue = 5 | pages = 1342–1354 | date = November 2020 | pmid = 33079853 | doi = 10.1213/ANE.0000000000005169 | s2cid = 224826657 | doi-access = free }}

{{Update section|date=February 2025}}

The leading preventable cause of death in the United States is tobacco; however, poor diet and lack of exercise may soon surpass tobacco as a leading cause of death. These behaviors are modifiable and public health and prevention efforts could make a difference to reduce these deaths.

The leading causes of preventable death worldwide share similar trends to the United States. There are a few differences between the two, such as malnutrition, pollution, and unsafe sanitation, that reflect health disparities between the developing and developed world.{{cite journal | vauthors = Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ | title = Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data | journal = Lancet | volume = 367 | issue = 9524 | pages = 1747–57 | date = May 2006 | pmid = 16731270 | doi = 10.1016/s0140-6736(06)68770-9 | s2cid = 22609505 }}

However, several of the leading causes of death – or underlying contributors to earlier death – may not be included as "preventable" causes of death. A study concluded that pollution was "responsible for approximately 9 million deaths per year" in 2019.{{cite journal |last1=Fuller |first1=Richard |last2=Landrigan |first2=Philip J |last3=Balakrishnan |first3=Kalpana |author-link3=Kalpana Balakrishnan |last4=Bathan |first4=Glynda |last5=Bose-O'Reilly |first5=Stephan |last6=Brauer |first6=Michael |last7=Caravanos |first7=Jack |last8=Chiles |first8=Tom |last9=Cohen |first9=Aaron |last10=Corra |first10=Lilian |last11=Cropper |first11=Maureen |last12=Ferraro |first12=Greg |last13=Hanna |first13=Jill |last14=Hanrahan |first14=David |last15=Hu |first15=Howard |date=May 2022 |title=Pollution and health: a progress update |journal=The Lancet Planetary Health |volume=6 |issue=6 |pages=e535–e547 |doi=10.1016/S2542-5196(22)00090-0 |pmid=35594895 |s2cid=248905224 |doi-access=free |last16=Hunter |first16=David |last17=Janata |first17=Gloria |last18=Kupka |first18=Rachael |last19=Lanphear |first19=Bruce |last20=Lichtveld |first20=Maureen |last21=Martin |first21=Keith |last22=Mustapha |first22=Adetoun |last23=Sanchez-Triana |first23=Ernesto |last24=Sandilya |first24=Karti |last25=Schaefli |first25=Laura |last26=Shaw |first26=Joseph |last27=Seddon |first27=Jessica |last28=Suk |first28=William |last29=Téllez-Rojo |first29=Martha María |last30=Yan |first30=Chonghuai}} And another study concluded that the global mean loss of life expectancy (a measure similar to years of potential life lost) from air pollution in 2015 was 2.9 years, substantially more than, for example, 0.3 years from all forms of direct violence, albeit a significant fraction of the LLE is considered to be unavoidable (such as pollution from some natural wildfires).{{cite journal |last1=Lelieveld |first1=Jos |last2=Pozzer |first2=Andrea |last3=Pöschl |first3=Ulrich |last4=Fnais |first4=Mohammed |last5=Haines |first5=Andy |last6=Münzel |first6=Thomas |title=Loss of life expectancy from air pollution compared to other risk factors: a worldwide perspective |journal=Cardiovascular Research |date=1 September 2020 |volume=116 |issue=11 |pages=1910–1917 |doi=10.1093/cvr/cvaa025 |pmid=32123898 |pmc=7449554 |issn=0008-6363}}

A landmark study conducted by the World Health Organization and the International Labour Organization found that exposure to long working hours is the occupational risk factor with the largest attributable burden of disease, i.e. an estimated 745,000 fatalities from ischemic heart disease and stroke events in 2016.{{cite journal | vauthors = Pega F, Náfrádi B, Momen NC, Ujita Y, Streicher KN, Prüss-Üstün AM, Descatha A, Driscoll T, Fischer FM, Godderis L, Kiiver HM, Li J, Magnusson Hanson LL, Rugulies R, Sørensen K, Woodruff TJ | display-authors = 6 | title = Global, regional, and national burdens of ischemic heart disease and stroke attributable to exposure to long working hours for 194 countries, 2000-2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury | journal = Environment International | volume = 154 | pages = 106595 | date = September 2021 | pmid = 34011457 | pmc = 8204267 | doi = 10.1016/j.envint.2021.106595 | doi-access = free | bibcode = 2021EnInt.15406595P }} With this study, prevention of exposure to long working hours has emerged as a priority for prevention healthcare in workplace settings.{{citation needed|date=June 2022}}

In 2010, 7.6 million children died before reaching the age of 5. While this is a decrease from 9.6 million in 2000,{{cite journal | vauthors = Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M, Mathers C, Black RE | display-authors = 6 | title = Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000 | journal = Lancet | volume = 379 | issue = 9832 | pages = 2151–61 | date = June 2012 | pmid = 22579125 | doi = 10.1016/s0140-6736(12)60560-1 | s2cid = 43866899 }} it was still far from the fourth Millennium Development Goal to decrease child mortality by two-thirds by 2015.Countdown to 2015, decade report (2000–10)—taking stock of maternal, newborn and child survival WHO, Geneva (2010) Of these deaths, about 64% were due to infection including diarrhea, pneumonia, and malaria. About 40% of these deaths occurred in neonates (children ages 1–28 days) due to pre-term birth complications. The highest number of child deaths occurred in Africa and Southeast Asia. As of 2015 in Africa, almost no progress has been made in reducing neonatal death since 1990. In 2010, India, Nigeria, Democratic Republic of the Congo, Pakistan, and China contributed to almost 50% of global child deaths. Targeting efforts in these countries is essential to reducing the global child death rate.

Child mortality is caused by factors including poverty, environmental hazards, and lack of maternal education.{{cite journal | vauthors = Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS | title = How many child deaths can we prevent this year? | journal = Lancet | volume = 362 | issue = 9377 | pages = 65–71 | date = July 2003 | pmid = 12853204 | doi = 10.1016/s0140-6736(03)13811-1 | s2cid = 17908665 }} In 2003, the World Health Organization created a list of interventions in the following table that were judged economically and operationally "feasible," based on the healthcare resources and infrastructure in 42 nations that contribute to 90% of all infant and child deaths. The table indicates how many infant and child deaths could have been prevented in 2000, assuming universal healthcare coverage.

Obesity is a major risk factor for a wide variety of conditions including cardiovascular diseases, hypertension, certain cancers, and type 2 diabetes. In order to prevent obesity, it is recommended that individuals adhere to a consistent exercise regimen as well as a nutritious and balanced diet. A healthy individual should aim for acquiring 10% of their energy from proteins, 15-20% from fat, and over 50% from complex carbohydrates, while avoiding alcohol as well as foods high in fat, salt, and sugar.{{cite journal | vauthors = Kumanyika S, Jeffery RW, Morabia A, Ritenbaugh C, Antipatis VJ | title = Obesity prevention: the case for action | journal = International Journal of Obesity and Related Metabolic Disorders | volume = 26 | issue = 3 | pages = 425–36 | date = March 2002 | pmid = 11896500 | doi = 10.1038/sj.ijo.0801938 | s2cid = 1410343 | doi-access = free }} Sedentary adults should aim for at least half an hour of moderate-level daily physical activity and eventually increase to include at least 20 minutes of intense exercise, three times a week. Preventive health care offers many benefits to those that chose to participate in taking an active role in the culture. The medical system in our society is geared toward curing acute symptoms of disease after the fact that they have brought us into the emergency room. An ongoing epidemic within American culture is the prevalence of obesity. Healthy eating and regular exercise play a significant role in reducing an individual's risk for type 2 diabetes. A 2008 study concluded that about 23.6 million people in the United States had diabetes, including 5.7 million that had not been diagnosed. 90 to 95 percent of people with diabetes have type 2 diabetes. Diabetes is the main cause of kidney failure, limb amputation, and new-onset blindness in American adults.{{Cite web|url=https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp|title=Diabetes Prevention Program (DPP) - NIDDK|website=National Institute of Diabetes and Digestive and Kidney Diseases}}

File:Arthur Szyk (1894-1951). Fool the Axis Use Prophylaxis poster (1942), Philadelphia.jpg

Sexually transmitted infections (STIs), such as syphilis and HIV, are common but preventable with safe-sex practices. STIs can be asymptomatic, or cause a range of symptoms. Preventive measures for STIs are called prophylactics. The term especially applies to the use of condoms,{{cite encyclopedia|title=Prophylactic|access-date=December 30, 2018|dictionary=Merriam-Webster|url=https://www.merriam-webster.com/dictionary/prophylactic}} which are highly effective at preventing disease,{{Cite web|url=https://www.cdc.gov/std/stats13/syphilis.htm|title = STD Data and Statistics|date = 2 August 2021}} but also to other devices meant to prevent STIs, such as dental dams and latex gloves. Other means for preventing STIs include education on how to use condoms or other such barrier devices, testing partners before having unprotected sex, receiving regular STI screenings, to both receive treatment and prevent spreading STIs to partners, and, specifically for HIV, regularly taking prophylactic antiretroviral drugs, such as Truvada. Post-exposure prophylaxis, started within 72 hours (optimally less than 1 hour) after exposure to high-risk fluids, can also protect against HIV transmission.{{citation needed|date=June 2022}}

Genetically modified mosquitoes are being used in developing countries to control malaria. This approach has been subject to objections and controversy.{{cite book | url=https://books.google.com/books?id=Sir5L1Gz23EC&q=genetically+modified+disease&pg=PA235| title= Ecological Aspects for Application of Genetically Modified Mosquitoes| publisher= University of California| work= Science | date= 1991 | vauthors = Takken W, Scott TW | pages=X| isbn= 9781402015854}}

{{main|Thrombosis prophylaxis}}

Thrombosis is a serious circulatory disease affecting thousands, usually older persons undergoing surgical procedures, women taking oral contraceptives and travelers. The consequences of thrombosis can be heart attacks and strokes. Prevention can include exercise, anti-embolism stockings, pneumatic devices, and pharmacological treatments.{{citation needed|date=July 2021}}

{{main|Cancer prevention}}

In recent years{{When|date=January 2023}}, cancer has become a global problem. Low and middle income countries share a majority of the cancer burden largely due to exposure to carcinogens resulting from industrialization and globalization.{{cite journal | vauthors = Vineis P, Wild CP | title = Global cancer patterns: causes and prevention | journal = Lancet | volume = 383 | issue = 9916 | pages = 549–57 | date = February 2014 | pmid = 24351322 | doi = 10.1016/s0140-6736(13)62224-2 | s2cid = 24822736 }} However, primary prevention of cancer and knowledge of cancer risk factors can reduce over one third of all cancer cases. Primary prevention of cancer can also prevent other diseases, both communicable and non-communicable, that share common risk factors with cancer.

File:Lung cancer US distribution.gif

Lung cancer is the leading cause of cancer-related deaths in the United States and Europe and is a major cause of death in other countries.{{cite journal | vauthors = Goodman GE | title = Prevention of lung cancer | journal = Critical Reviews in Oncology/Hematology | volume = 33 | issue = 3 | pages = 187–97 | date = March 2000 | pmid = 10789492 | doi = 10.1016/s1040-8428(99)00074-8 }} Tobacco is an environmental carcinogen and the major underlying cause of lung cancer. Between 25% and 40% of all cancer deaths and about 90% of lung cancer cases are associated with tobacco use. Other carcinogens include asbestos and radioactive materials.{{cite journal | vauthors = Risser NL | title = Prevention of lung cancer: the key is to stop smoking | journal = Seminars in Oncology Nursing | volume = 12 | issue = 4 | pages = 260–9 | date = November 1996 | pmid = 8936641 | doi = 10.1016/S0749-2081(96)80024-6 }} Both smoking and second-hand exposure from other smokers can lead to lung cancer and eventually death.

Prevention of tobacco use is paramount to prevention of lung cancer. Individual, community, and statewide interventions can prevent or cease tobacco use. 90% of adults in the U.S. who have ever smoked did so prior to the age of 20. In-school prevention/educational programs, as well as counseling resources, can help prevent and cease adolescent smoking. Other cessation techniques include group support programs, nicotine replacement therapy (NRT), hypnosis, and self-motivated behavioral change. Studies have shown long term success rates (>1 year) of 20% for hypnosis and 10%-20% for group therapy.

Cancer screening programs serve as effective sources of secondary prevention. The Mayo Clinic, Johns Hopkins, and Memorial Sloan-Kettering hospitals conducted annual x-ray screenings and sputum cytology tests and found that lung cancer was detected at higher rates, earlier stages, and had more favorable treatment outcomes, which supports widespread investment in such programs.

Legislation can also affect smoking prevention and cessation. In 1992, Massachusetts (United States) voters passed a bill adding an extra 25 cent tax to each pack of cigarettes, despite intense lobbying and $7.3 million spent by the tobacco industry to oppose this bill. Tax revenue goes toward tobacco education and control programs and has led to a decline of tobacco use in the state.{{cite journal | vauthors = Koh HK | title = An analysis of the successful 1992 Massachusetts tobacco tax initiative | journal = Tobacco Control | volume = 5 | issue = 3 | pages = 220–5 | year = 1996 | pmid = 9035358 | pmc = 1759517 | doi = 10.1136/tc.5.3.220 }}

Lung cancer and tobacco smoking are increasing worldwide, especially in China. China is responsible for about one-third of the global consumption and production of tobacco products.{{cite journal | vauthors = Zhang J, Ou JX, Bai CX | title = Tobacco smoking in China: prevalence, disease burden, challenges and future strategies | journal = Respirology | volume = 16 | issue = 8 | pages = 1165–72 | date = November 2011 | pmid = 21910781 | doi = 10.1111/j.1440-1843.2011.02062.x | s2cid = 29359959 | doi-access = free }} Tobacco control policies have been ineffective as China is home to 350 million regular smokers and 750 million passive smokers and the annual death toll is over 1 million. Recommended actions to reduce tobacco use include decreasing tobacco supply, increasing tobacco taxes, widespread educational campaigns, decreasing advertising from the tobacco industry, and increasing tobacco cessation support resources. In Wuhan, China, a 1998 school-based program implemented an anti-tobacco curriculum for adolescents and reduced the number of regular smokers, though it did not significantly decrease the number of adolescents who initiated smoking. This program was therefore effective in secondary but not primary prevention and shows that school-based programs have the potential to reduce tobacco use.{{cite journal | vauthors = Chou CP, Li Y, Unger JB, Xia J, Sun P, Guo Q, Shakib S, Gong J, Xie B, Liu C, Azen S, Shan J, Ma H, Palmer P, Gallaher P, Johnson CA | display-authors = 6 | title = A randomized intervention of smoking for adolescents in urban Wuhan, China | journal = Preventive Medicine | volume = 42 | issue = 4 | pages = 280–5 | date = April 2006 | pmid = 16487998 | doi = 10.1016/j.ypmed.2006.01.002 }}

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Skin cancer is the most common cancer in the United States.MMWR. Recommendations and Reports : Morbidity and Mortality Weekly Report. Recommendations and Reports / Centers for Disease Control [2002, 51(RR-4):1-18] The most lethal form of skin cancer, melanoma, leads to over 50,000 annual deaths in the United States. Childhood prevention is particularly important because a significant portion of ultraviolet radiation exposure from the sun occurs during childhood and adolescence and can subsequently lead to skin cancer in adulthood. Furthermore, childhood prevention can lead to the development of healthy habits that continue to prevent cancer for a lifetime.

The Centers for Disease Control and Prevention (CDC) recommends several primary prevention methods including: limiting sun exposure between 10 AM and 4 PM, when the sun is strongest, wearing tighter-weave natural cotton clothing, wide-brim hats, and sunglasses as protective covers, using sunscreens that protect against both UV-A and UV-B rays, and avoiding tanning salons. Sunscreen should be reapplied after sweating, exposure to water (through swimming for example) or after several hours of sun exposure. Since skin cancer is very preventable, the CDC recommends school-level prevention programs including preventive curricula, family involvement, participation and support from the school's health services, and partnership with community, state, and national agencies and organizations to keep children away from excessive UV radiation exposure.

Most skin cancer and sun protection data comes from Australia and the United States.{{cite journal | vauthors = Stanton WR, Janda M, Baade PD, Anderson P | title = Primary prevention of skin cancer: a review of sun protection in Australia and internationally | journal = Health Promotion International | volume = 19 | issue = 3 | pages = 369–78 | date = September 2004 | pmid = 15306621 | doi = 10.1093/heapro/dah310 | doi-access = free }} An international study reported that Australians tended to demonstrate higher knowledge of sun protection and skin cancer knowledge, compared to other countries. Of children, adolescents, and adults, sunscreen was the most commonly used skin protection. However, many adolescents purposely used sunscreen with a low sun protection factor (SPF) in order to get a tan. Various Australian studies have shown that many adults failed to use sunscreen correctly; many applied sunscreen well after their initial sun exposure and/or failed to reapply when necessary.{{cite journal | vauthors = Broadstock M | title = Sun protection at the cricket | journal = The Medical Journal of Australia | volume = 154 | issue = 6 | pages = 430 | date = March 1991 | pmid = 2000067 | doi = 10.5694/j.1326-5377.1991.tb121157.x | s2cid = 20079122 }}{{cite journal | vauthors = Pincus MW, Rollings PK, Craft AB, Green A | title = Sunscreen use on Queensland beaches | journal = The Australasian Journal of Dermatology | volume = 32 | issue = 1 | pages = 21–5 | year = 1991 | pmid = 1930002 | doi = 10.1111/j.1440-0960.1991.tb00676.x | s2cid = 36682427 }}{{cite journal | vauthors = Hill D, White V, Marks R, Theobald T, Borland R, Roy C | title = Melanoma prevention: behavioral and nonbehavioral factors in sunburn among an Australian urban population | journal = Preventive Medicine | volume = 21 | issue = 5 | pages = 654–69 | date = September 1992 | pmid = 1438112 | doi = 10.1016/0091-7435(92)90072-p }} A 2002 case-control study in Brazil showed that only 3% of case participants and 11% of control participants used sunscreen with SPF >15.{{cite journal | vauthors = Bakos L, Wagner M, Bakos RM, Leite CS, Sperhacke CL, Dzekaniak KS, Gleisner AL | title = Sunburn, sunscreens, and phenotypes: some risk factors for cutaneous melanoma in southern Brazil | journal = International Journal of Dermatology | volume = 41 | issue = 9 | pages = 557–62 | date = September 2002 | pmid = 12358823 | doi = 10.1046/j.1365-4362.2002.01412.x | s2cid = 31890013 }}

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Cervical cancer ranks among the top three most common cancers among women in Latin America, sub-Saharan Africa, and parts of Asia. Cervical cytology screening aims to detect abnormal lesions in the cervix so that women can undergo treatment prior to the development of cancer. Given that high quality screening and follow-up care has been shown to reduce cervical cancer rates by up to 80%, most developed countries now encourage sexually active women to undergo a Pap test every 3–5 years. Finland and Iceland have developed effective organized programs with routine monitoring and have managed to significantly reduce cervical cancer mortality while using fewer resources than unorganized, opportunistic programs such as those in the United States or Canada.{{cite journal | vauthors = Sankaranarayanan R, Budukh AM, Rajkumar R | title = Effective screening programmes for cervical cancer in low- and middle-income developing countries | journal = Bulletin of the World Health Organization | volume = 79 | issue = 10 | pages = 954–62 | year = 2001 | pmid = 11693978 | pmc = 2566667 }}

In developing nations in Latin America, such as Chile, Colombia, Costa Rica, and Cuba, both public and privately organized programs have offered women routine cytological screening since the 1970s. However, these efforts have not resulted in a significant change in cervical cancer incidence or mortality in these nations. This is likely due to low quality, inefficient testing. However, Puerto Rico, which has offered early screening since the 1960s, has witnessed almost a 50% decline in cervical cancer incidence and almost a four-fold decrease in mortality between 1950 and 1990. Brazil, Peru, India, and several high-risk nations in sub-Saharan Africa which lack organized screening programs, have a high incidence of cervical cancer.

Colorectal cancer is globally the second most common cancer in women and the third-most common in men,{{cite book | title=World Cancer Report 2014 | publisher=International Agency for Research on Cancer, World Health Organization | date=2014 | isbn=978-92-832-0432-9}} and the fourth most common cause of cancer death after lung, stomach, and liver cancer,{{cite web | title=Cancer | publisher=World Health Organization | date=February 2010 | url=https://www.who.int/mediacentre/factsheets/fs297/en/ | access-date=January 5, 2011}} having caused 715,000 deaths in 2010.{{cite journal | vauthors = Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L, Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KM, Nasseri K, Norman P, O'Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA | display-authors = 6 | title = Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2095–128 | date = December 2012 | pmid = 23245604 | doi = 10.1016/S0140-6736(12)61728-0 | s2cid = 1541253 | hdl = 10536/DRO/DU:30050819 | url = http://www.cobiss.si/scripts/cobiss?command=DISPLAY&base=cobib&rid=1537267652&fmt=11 | pmc = 10790329 }}

It is also highly preventable; about 80 percent{{cite web | vauthors = Burke CA, Bianchi LK | title=Colorectal Neoplasia | publisher=Cleveland Clinic | url=http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastroenterology/colorectal-neoplasia/ | access-date=January 12, 2015}} of colorectal cancers begin as benign growths, commonly called polyps, which can be easily detected and removed during a colonoscopy. Other methods of screening for polyps and cancers include fecal occult blood testing. Lifestyle changes that may reduce the risk of colorectal cancer include increasing consumption of whole grains, fruits and vegetables, and reducing consumption of red meat.{{citation needed|date=July 2021}}

{{excerpt|Prevention of dementia}}

Access to healthcare and preventive health services is unequal, as is the quality of care received. A study conducted by the Agency for Healthcare Research and Quality (AHRQ) revealed health disparities in the United States. In the United States, elderly adults (>65 years old) received worse care and had less access to care than their younger counterparts. The same trends are seen when comparing all racial minorities (black, Hispanic, Asian) to white patients, and low-income people to high-income people. Common barriers to accessing and utilizing healthcare resources included lack of income and education, language barriers, and lack of health insurance. Minorities were less likely than whites to possess health insurance, as were individuals who completed less education. These disparities made it more difficult for the disadvantaged groups to have regular access to a primary care provider, receive immunizations, or receive other types of medical care.{{cite web | title = Disparities in Healthcare Quality Among Racial and Ethnic Groups: Selected Findings from the 2011 National Healthcare Quality and Disparities Reports. Fact Sheet. | id = AHRQ Publication No. 12-0006-1-EF | date = September 2012 | publisher = Agency for Healthcare Research and Quality | location = Rockville, MD | url = http://www.ahrq.gov/qual/nhqrdr11/nhqrdrminority11.htm }} Additionally, uninsured people tend to not seek care until their diseases progress to chronic and serious states and they are also more likely to forgo necessary tests, treatments, and filling prescription medications.{{cite journal | vauthors = Carrillo JE, Carrillo VA, Perez HR, Salas-Lopez D, Natale-Pereira A, Byron AT | title = Defining and targeting health care access barriers | journal = Journal of Health Care for the Poor and Underserved | volume = 22 | issue = 2 | pages = 562–75 | date = May 2011 | pmid = 21551934 | doi = 10.1353/hpu.2011.0037 | s2cid = 42283926 }}

These sorts of disparities and barriers exist worldwide as well. Often, there are decades of gaps in life expectancy between developing and developed countries. For example, Japan has an average life expectancy that is 36 years greater than that in Malawi.{{Cite web|url=http://www.who.int/sdhconference/background/news/facts/en/|archive-url=https://web.archive.org/web/20111109005506/http://www.who.int/sdhconference/background/news/facts/en/|url-status=dead|archive-date=November 9, 2011|title = WHO | Fact file on health inequities}} Low-income countries also tend to have fewer physicians than high-income countries. In Nigeria and Myanmar, there are fewer than 4 physicians per 100,000 people while Norway and Switzerland have a ratio that is ten-fold higher. Common barriers worldwide include lack of availability of health services and healthcare providers in the region, great physical distance between the home and health service facilities, high transportation costs, high treatment costs, and social norms and stigma toward accessing certain health services.{{cite journal | vauthors = Jacobs B, Ir P, Bigdeli M, Annear PL, Van Damme W | title = Addressing access barriers to health services: an analytical framework for selecting appropriate interventions in low-income Asian countries | journal = Health Policy and Planning | volume = 27 | issue = 4 | pages = 288–300 | date = July 2012 | pmid = 21565939 | doi = 10.1093/heapol/czr038 | doi-access = free }}

With lifestyle factors such as diet and exercise rising to the top of preventable death statistics, the economics of healthy lifestyle is a growing concern. There is little question that positive lifestyle choices provide an investment in health throughout life.{{Cite book|url=https://www.ncbi.nlm.nih.gov/books/NBK53914/|title=Missed Prevention Opportunities | vauthors = ((Institute of Medicine (US) Roundtable on Evidence-Based Medicine)), Yong PL, Saunders RS, Olsen LA |date=2010-01-01|publisher=National Academies Press (US)|language=en}} To gauge success, traditional measures such as the quality years of life method (QALY), show great value.{{cite journal | vauthors = Arenas DJ, Lett LA, Klusaritz H, Teitelman AM | title = A Monte Carlo simulation approach for estimating the health and economic impact of interventions provided at a student-run clinic | journal = PLOS ONE | volume = 12 | issue = 12 | pages = e0189718 | date = 28 December 2017 | pmid = 29284026 | pmc = 5746244 | doi = 10.1371/journal.pone.0189718 | doi-access = free | bibcode = 2017PLoSO..1289718A }} However, that method does not account for the cost of chronic conditions or future lost earnings because of poor health.{{Citation |title=A Review and Analysis of Economic Models of Prevention Benefits |doi=10.13140/RG.2.1.1225.6803 |year=2013 | vauthors = Haninger K, Miller W, Rein D, O'Grady M, Yeung JE, Eichner J, McMahon M }}

Developing future economic models that would guide both private and public investments as well as drive future policy to evaluate the efficacy of positive lifestyle choices on health is a major topic for economists globally. Americans spend over three trillion a year on health care but have a higher rate of infant mortality, shorter life expectancies, and a higher rate of diabetes than other high-income nations because of negative lifestyle choices.{{Cite news|url=https://www.usnews.com/opinion/blogs/policy-dose/2015/05/28/focus-on-prevention-to-cut-us-health-care-costs|title=US Healthcare reform should focus on prevention efforts to cut skyrocketing costs| vauthors =Frist B |date=May 28, 2015|work=U.S. News & World Report|access-date=2016-03-24|archive-url=https://web.archive.org/web/20150528205913/http://www.usnews.com/opinion/blogs/policy-dose/2015/05/28/focus-on-prevention-to-cut-us-health-care-costs|archive-date=2015-05-28|url-status=dead}} Despite these large costs, very little is spent on prevention for lifestyle-caused conditions in comparison. In 2016, the Journal of the American Medical Association estimated that $101 billion was spent in 2013 on the preventable disease of diabetes, and another $88 billion was spent on heart disease.{{cite journal | vauthors = Dieleman JL, Baral R, Birger M, Bui AL, Bulchis A, Chapin A, Hamavid H, Horst C, Johnson EK, Joseph J, Lavado R, Lomsadze L, Reynolds A, Squires E, Campbell M, DeCenso B, Dicker D, Flaxman AD, Gabert R, Highfill T, Naghavi M, Nightingale N, Templin T, Tobias MI, Vos T, Murray CJ | display-authors = 6 | title = US Spending on Personal Health Care and Public Health, 1996-2013 | journal = JAMA | volume = 316 | issue = 24 | pages = 2627–2646 | date = December 2016 | pmid = 28027366 | pmc = 5551483 | doi = 10.1001/jama.2016.16885 }} In an effort to encourage healthy lifestyle choices, as of 2010 workplace wellness programs were on the rise but the economics and effectiveness data were continuing to evolve and develop.{{cite journal | vauthors = Baicker K, Cutler D, Song Z | title = Workplace wellness programs can generate savings | journal = Health Affairs | volume = 29 | issue = 2 | pages = 304–11 | date = February 2010 | pmid = 20075081 | doi = 10.1377/hlthaff.2009.0626 }}

Health insurance coverage impacts lifestyle choices, even intermittent loss of coverage had negative effects on healthy choices in the U.S.{{cite journal | vauthors = Sudano JJ, Baker DW | title = Intermittent lack of health insurance coverage and use of preventive services | journal = American Journal of Public Health | volume = 93 | issue = 1 | pages = 130–7 | date = January 2003 | pmid = 12511402 | pmc = 1447707 | doi = 10.2105/AJPH.93.1.130 }} The repeal of the Affordable Care Act (ACA) could significantly impact coverage for many Americans as well as "The Prevention and Public Health Fund" which is the U.S. first and only mandatory funding stream dedicated to improving public health{{Cite web|url=https://www.apha.org/~/media/files/pdf/factsheets/170125_pphf.ashx|title=Prevention and Public Health Fund|website=American Public Health Association|access-date=2017-03-24}} including counseling on lifestyle prevention issues, such as weight management, alcohol use, and treatment for depression.{{Cite news|url=https://www.hhs.gov/healthcare/about-the-aca/preventive-care/index.html|title=Preventive Care|last=(ASPA)|first=Assistant Secretary for Public Affairs|date=2013-06-10|work=HHS.gov|access-date=2017-03-24|language=en}}

Because in the U.S. chronic illnesses predominate as a cause of death and pathways for treating chronic illnesses are complex and multifaceted, prevention is a best practice approach to chronic disease when possible. In many cases, prevention requires mapping complex pathways{{Cite book|title=Pathway to the Prevention of Child Abuse and Neglect| vauthors = Schorr LB |publisher=Harvard University|year=2007|url=http://www.childsworld.ca.gov/res/pdf/Pathway.pdf}} to determine the ideal point for intervention. Cost-effectiveness of prevention is achievable, but impacted by the length of time it takes to see effects/outcomes of intervention. This makes prevention efforts difficult to fund—particularly in strained financial contexts. Prevention potentially creates other costs as well, due to extending the lifespan and thereby increasing opportunities for illness. In order to assess the cost-effectiveness of prevention, the cost of the preventive measure, savings from avoiding morbidity, and the cost from extending the lifespan need to be considered.{{cite journal | vauthors = Gandjour A | title = Aging diseases--do they prevent preventive health care from saving costs? | journal = Health Economics | volume = 18 | issue = 3 | pages = 355–62 | date = March 2009 | pmid = 18833543 | doi = 10.1002/hec.1370 }} Life extension costs become smaller when accounting for savings from postponing the last year of life,{{cite journal | vauthors = Gandjour A, Lauterbach KW | title = Does prevention save costs? Considering deferral of the expensive last year of life | journal = Journal of Health Economics | volume = 24 | issue = 4 | pages = 715–24 | date = July 2005 | pmid = 15960993 | doi = 10.1016/j.jhealeco.2004.11.009 }} which makes up a large fraction of lifetime medical expenditures{{cite journal | vauthors = Fuchs VR | title = "Though much is taken": reflections on aging, health, and medical care | journal = The Milbank Memorial Fund Quarterly. Health and Society | volume = 62 | issue = 2 | pages = 143–66 | date = 1984 | pmid = 6425716 | doi = 10.2307/3349821 | url = http://www.nber.org/papers/w1269.pdf | s2cid = 25579469 | jstor = 3349821 }} and becomes cheaper with age.{{cite journal | vauthors = Yang Z, Norton EC, Stearns SC | title = Longevity and health care expenditures: the real reasons older people spend more | journal = The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences | volume = 58 | issue = 1 | pages = S2-10 | date = January 2003 | pmid = 12496303 | doi = 10.1093/geronb/58.1.S2 | doi-access = free }} Prevention leads to savings only if the cost of the preventive measure is less than the savings from avoiding morbidity net of the cost of extending the life span. In order to establish reliable economics of prevention for illnesses that are complicated in origin, knowing how best to assess prevention efforts, i.e. developing useful measures and appropriate scope, is required.{{Cite web|url=http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/obesity-and-the-economics-of-prevention_9789264084865-en|title=Obesity and the Economics of Prevention {{!}} OECD READ edition|website=OECD iLibrary|language=en|access-date=2017-03-27}}

There is no general consensus as to whether or not preventive healthcare measures are cost-effective,{{according to whom |date=April 2020}} but they increase the quality of life dramatically. There are varying views on what constitutes a "good investment." Some argue that preventive health measures should save more money than they cost, when factoring in treatment costs in the absence of such measures.{{cite journal | vauthors = Maciosek MV, Coffield AB, Flottemesch TJ, Edwards NM, Solberg LI | title = Greater use of preventive services in U.S. health care could save lives at little or no cost | journal = Health Affairs | volume = 29 | issue = 9 | pages = 1656–60 | date = September 2010 | pmid = 20820022 | doi = 10.1377/hlthaff.2008.0701 }} Others have argued in favor of "good value" or conferring significant health benefits even if the measures do not save money.{{cite journal | vauthors = Russell LB | title = The role of prevention in health reform | journal = The New England Journal of Medicine | volume = 329 | issue = 5 | pages = 352–4 | date = July 1993 | pmid = 8321264 | doi = 10.1056/nejm199307293290511 }} Furthermore, preventive health services are often described as one entity though they comprise a myriad of different services, each of which can individually lead to net costs, savings, or neither. Greater differentiation of these services is necessary to fully understand both the financial and health effects.

A 2010 study reported that in the United States, vaccinating children, cessation of smoking, daily prophylactic use of aspirin, and screening of breast and colorectal cancers had the most potential to prevent premature death. Preventive health measures that resulted in savings included vaccinating children and adults, smoking cessation, daily use of aspirin, and screening for issues with alcoholism, obesity, and vision failure. These authors estimated that if usage of these services in the United States increased to 90% of the population, there would be net savings of $3.7 billion, which comprised only about -0.2% of the total 2006 United States healthcare expenditure. Despite the potential for decreasing healthcare spending, utilization of healthcare resources in the United States still remains low, especially among Latinos and African-Americans.{{cite journal | vauthors = Maciosek MV, Coffield AB, Edwards NM, Flottemesch TJ, Goodman MJ, Solberg LI | title = Priorities among effective clinical preventive services: results of a systematic review and analysis | journal = American Journal of Preventive Medicine | volume = 31 | issue = 1 | pages = 52–61 | date = July 2006 | pmid = 16777543 | doi = 10.1016/j.amepre.2006.03.012 }} Overall, preventive services are difficult to implement because healthcare providers have limited time with patients and must integrate a variety of preventive health measures from different sources.

While these specific services bring about small net savings, not every preventive health measure saves more than it costs. A 1970s study showed that preventing heart attacks by treating hypertension early on with drugs actually did not save money in the long run. The money saved by evading treatment from heart attack and stroke only amounted to about a quarter of the cost of the drugs.Weinstein MC, Stason WB. "Hypertension: a policy perspective. Cambridge, Mass.: Harvard University Press, 1976.{{cite journal | vauthors = Weinstein MC, Stason WB | title = Economic considerations in the management of mild hypertension | journal = Annals of the New York Academy of Sciences | volume = 304 | issue = 1 | pages = 424–40 | date = March 1978 | pmid = 101118 | doi = 10.1111/j.1749-6632.1978.tb25625.x | s2cid = 46598377 | bibcode = 1978NYASA.304..424W }} Similarly, it was found that the cost of drugs or dietary changes to decrease high blood cholesterol exceeded the cost of subsequent heart disease treatment.

Taylor WC, Pass TM, Shepard DS, Komaroff AL. Cost effectiveness of cholesterol reduction for the primary prevention of coronary heart disease in men. In: Goldbloom RB, Lawrence RS, eds. Preventing disease: beyond the rhetoric. New York: Springer-Verlag, 1990:437-41.{{cite journal | vauthors = Goldman L, Weinstein MC, Goldman PA, Williams LW | title = Cost-effectiveness of HMG-CoA reductase inhibition for primary and secondary prevention of coronary heart disease | journal = JAMA | volume = 265 | issue = 9 | pages = 1145–51 | date = March 1991 | pmid = 1899896 | doi = 10.1001/jama.265.9.1145 }} Due to these findings, some argue that rather than focusing healthcare reform efforts exclusively on preventive care, the interventions that bring about the highest level of health should be prioritized.

In 2008, Cohen et al. outlined a few arguments made by skeptics of preventive healthcare. Many argue that preventive measures only cost less than future treatment when the proportion of the population that would become ill in the absence of prevention is fairly large.{{cite journal | vauthors = Cohen JT, Neumann PJ, Weinstein MC | title = Does preventive care save money? Health economics and the presidential candidates | journal = The New England Journal of Medicine | volume = 358 | issue = 7 | pages = 661–3 | date = February 2008 | pmid = 18272889 | doi = 10.1056/nejmp0708558 | doi-access = free }} The Diabetes Prevention Program Research Group conducted a 2012 study evaluating the costs and benefits in quality-adjusted life-years or QALYs of lifestyle changes versus taking the drug metformin. They found that neither method brought about financial savings, but were cost-effective nonetheless because they brought about an increase in QALYs.{{cite journal | author = The Diabetes Prevention Program Research Group | title = The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: an intent-to-treat analysis of the DPP/DPPOS | journal = Diabetes Care | volume = 35 | issue = 4 | pages = 723–30 | date = April 2012 | pmid = 22442395 | pmc = 3308273 | doi = 10.2337/dc11-1468 }} In addition to scrutinizing costs, preventive healthcare skeptics also examine efficiency of interventions. They argue that while many treatments of existing diseases involve use of advanced equipment and technology, in some cases, this is a more efficient use of resources than attempts to prevent the disease. Cohen suggested that the preventive measures most worth exploring and investing in are those that could benefit a large portion of the population to bring about cumulative and widespread health benefits at a reasonable cost.

There are at least four nationally implemented childhood obesity interventions in the United States: the Sugar-Sweetened Beverage excise tax (SSB), the TV AD program, active physical education (Active PE) policies, and early care and education (ECE) policies.{{cite journal | vauthors = Gortmaker SL, Long MW, Resch SC, Ward ZJ, Cradock AL, Barrett JL, Wright DR, Sonneville KR, Giles CM, Carter RC, Moodie ML, Sacks G, Swinburn BA, Hsiao A, Vine S, Barendregt J, Vos T, Wang YC | display-authors = 6 | title = Cost Effectiveness of Childhood Obesity Interventions: Evidence and Methods for CHOICES | journal = American Journal of Preventive Medicine | volume = 49 | issue = 1 | pages = 102–11 | date = July 2015 | pmid = 26094231 | doi = 10.1016/j.amepre.2015.03.032 | pmc = 9508900 }} They each have similar goals of reducing childhood obesity. The effects of these interventions on BMI have been studied, and the cost-effectiveness analysis (CEA) has led to a better understanding of projected cost reductions and improved health outcomes.{{cite journal | vauthors = Barrett JL, Gortmaker SL, Long MW, Ward ZJ, Resch SC, Moodie ML, Carter R, Sacks G, Swinburn BA, Wang YC, Cradock AL | display-authors = 6 | title = Cost Effectiveness of an Elementary School Active Physical Education Policy | journal = American Journal of Preventive Medicine | volume = 49 | issue = 1 | pages = 148–59 | date = July 2015 | pmid = 26094235 | doi = 10.1016/j.amepre.2015.02.005 }}{{cite journal | vauthors = Wright DR, Kenney EL, Giles CM, Long MW, Ward ZJ, Resch SC, Moodie ML, Carter RC, Wang YC, Sacks G, Swinburn BA, Gortmaker SL, Cradock AL | display-authors = 6 | title = Modeling the Cost Effectiveness of Child Care Policy Changes in the U.S | journal = American Journal of Preventive Medicine | volume = 49 | issue = 1 | pages = 135–47 | date = July 2015 | pmid = 26094234 | doi = 10.1016/j.amepre.2015.03.016 }} The Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) was conducted to evaluate and compare the CEA of these four interventions.

Gortmaker, S.L. et al. (2015) states: "The four initial interventions were selected by the investigators to represent a broad range of nationally scalable strategies to reduce childhood obesity using a mix of both policy and programmatic strategies... 1. an excise tax of $0.01 per ounce of sweetened beverages, applied nationally and administered at the state level (SSB), 2. elimination of the tax deductibility of advertising costs of TV advertisements for "nutritionally poor" foods and beverages seen by children and adolescents (TV AD), 3. state policy requiring all public elementary schools in which physical education (PE) is currently provided to devote ≥50% of PE class time to moderate and vigorous physical activity (Active PE), and 4. state policy to make early child educational settings healthier by increasing physical activity, improving nutrition, and reducing screen time (ECE)." The CHOICES found that SSB, TV AD, and ECE led to net cost savings. Both SSB and TV AD increased quality adjusted life years and produced yearly tax revenue of 12.5 billion U.S. dollars and 80 million U.S. dollars, respectively.{{citation needed|date=July 2021}}

Some challenges with evaluating the effectiveness of child obesity interventions include:

1. The economic consequences of childhood obesity are both short and long term. In the short term, obesity impairs cognitive achievement and academic performance. Some believe this is secondary to negative effects on mood or energy, but others suggest there may be physiological factors involved.{{cite journal | vauthors = Black N, Johnston DW, Peeters A | title = Childhood Obesity and Cognitive Achievement | journal = Health Economics | volume = 24 | issue = 9 | pages = 1082–100 | date = September 2015 | pmid = 26123250 | doi = 10.1002/hec.3211 }} Furthermore, obese children have increased health care expenses (e.g. medications, acute care visits). In the long term, obese children tend to become obese adults with associated increased risk for a chronic condition such as diabetes or hypertension.{{cite journal | vauthors = Schmeiser MD | title = The impact of long-term participation in the supplemental nutrition assistance program on child obesity | journal = Health Economics | volume = 21 | issue = 4 | pages = 386–404 | date = April 2012 | pmid = 21305645 | doi = 10.1002/hec.1714 }}{{cite journal | vauthors = Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T | title = Do obese children become obese adults? A review of the literature | journal = Preventive Medicine | volume = 22 | issue = 2 | pages = 167–77 | date = March 1993 | pmid = 8483856 | doi = 10.1006/pmed.1993.1014 }} Any effect on their cognitive development may also affect their contributions to society and socioeconomic status.
2. In the CHOICES, it was noted that translating the effects of these interventions may in fact differ among communities throughout the nation. In addition it was suggested that limited outcomes are studied and these interventions may have an additional effect that is not fully appreciated.
3. Modeling outcomes in such interventions in children over the long term is challenging because advances in medicine and medical technology are unpredictable. The projections from cost-effective analysis may need to be reassessed more frequently.

As of 2009, the cost-effectiveness of preventive care is a highly debated topic. While some economists argue that preventive care is valuable and potentially cost saving, others believe it is an inefficient waste of resources.{{Cite web|url=http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2009/rwjf46045/subassets/rwjf46045_1|title=The cost savings and cost-effectiveness of clinical preventative [sic] care. Robert Wood Johnson Foundation| vauthors = Cohen J |website= The Synthesis Project |publisher=Robert Wood Johnson Foundation|access-date=March 24, 2016}} Preventive care is composed of a variety of clinical services and programs including annual doctor's check-ups, annual immunizations, and wellness programs; recent models show that these simple interventions can have significant economic impacts.

Research on preventive care addresses the question of whether it is cost saving or cost effective and whether there is an economics evidence base for health promotion and disease prevention. The need for and interest in preventive care is driven by the imperative to reduce health care costs while improving quality of care and the patient experience. Preventive care can lead to improved health outcomes and cost savings potential. Services such as health assessments/screenings, prenatal care, and telehealth and telemedicine can reduce morbidity or mortality with low cost or cost savings.{{Cite web|url=http://eprints.lse.ac.uk/55659/|title = Promoting health, preventing disease: Is there an economic case?|year = 2013}}{{Cite book|title=Promoting health, preventing disease: the economic case| vauthors = Merkur S, Sassi F, McDaid D |isbn=9780335262267|oclc=973090310|date = June 2015| publisher = McGraw-Hill Education }} Specifically, health assessments/screenings have cost savings potential, with varied cost-effectiveness based on screening and assessment type.{{cite journal | vauthors = Hackl F, Halla M, Hummer M, Pruckner GJ | title = The Effectiveness of Health Screening | journal = Health Economics | volume = 24 | issue = 8 | pages = 913–35 | date = August 2015 | pmid = 25044494 | doi = 10.1002/hec.3072 | url = http://www.econ.jku.at/papers/2012/wp1201.pdf | s2cid = 2618931 | hdl = 10419/115079 }} Inadequate prenatal care can lead to an increased risk of prematurity, stillbirth, and infant death.{{cite journal | vauthors = Partridge S, Balayla J, Holcroft CA, Abenhaim HA | title = Inadequate prenatal care utilization and risks of infant mortality and poor birth outcome: a retrospective analysis of 28,729,765 U.S. deliveries over 8 years | journal = American Journal of Perinatology | volume = 29 | issue = 10 | pages = 787–93 | date = November 2012 | pmid = 22836820 | doi = 10.1055/s-0032-1316439 | s2cid = 25060507 }} Time is the ultimate resource and preventive care can help mitigate the time costs.Folland, S., Goodman, A., & Stano, M. (2013). The economics of health and health care. (7th ed.). Upper Saddle River: Pearson Education. Telehealth and telemedicine is one option that has gained consumer interest, acceptance, and confidence and can improve quality of care and patient satisfaction.{{Cite journal |last1=Cantor |first1=Amy G. |last2=Jungbauer |first2=Rebecca M. |last3=Totten |first3=Annette M. |last4=Tilden |first4=Ellen L. |last5=Holmes |first5=Rebecca |last6=Ahmed |first6=Azrah |last7=Wagner |first7=Jesse |last8=Hermesch |first8=Amy C. |last9=McDonagh |first9=Marian S. |date=2022 |title=Telehealth Strategies for the Delivery of Maternal Health Care: A Rapid Review |url=https://www.acpjournals.org/doi/10.7326/M22-0737 |journal=Annals of Internal Medicine |language=en |volume=175 |issue=9 |pages=1285–1297 |doi=10.7326/M22-0737 |pmid=35878405 |s2cid=251067668 |issn=0003-4819}}

There are benefits and trade-offs when considering investment in preventive care versus other types of clinical services. Preventive care can be a good investment as supported by the evidence base and can drive population health management objectives. The concepts of cost saving and cost-effectiveness are different and both are relevant to preventive care. Preventive care that may not save money may still provide health benefits; thus, there is a need to compare interventions relative to impact on health and cost.Robert Wood Johnson Foundation. (2009). The cost savings and cost-effectiveness of clinical preventive care. The Synthesis Project: New Insights from Research Results. Research Synthesis Report No. 18.

Preventive care transcends demographics and is applicable to people of every age. The Health Capital Theory underpins the importance of preventive care across the lifecycle and provides a framework for understanding the variances in health and health care that are experienced. It treats health as a stock that provides direct utility. Health depreciates with age and the aging process can be countered through health investments. The theory further supports that individuals demand good health, that the demand for health investment is a derived demand (i.e. investment is health is due to the underlying demand for good health), and the efficiency of the health investment process increases with knowledge (i.e. it is assumed that the more educated are more efficient consumers and producers of health).{{cite book | vauthors = Galama TJ, van Kippersluis H | year = 2013 | title = Health Inequalities through the Lens of Health Capital Theory: Issues, Solutions, and Future Directions | volume = 21 | pages = 263–284 | doi=10.1108/S1049-2585(2013)0000021013| pmid = 24570580 | pmc = 3932058 | series = Research on Economic Inequality | isbn = 978-1-78190-553-1 | chapter = Health Inequalities through the Lens of Health-Capital Theory: Issues, Solutions, and Future Directions }}

The prevalence elasticity of demand for prevention can also provide insights into the economics. Demand for preventive care can alter the prevalence rate of a given disease and further reduce or even reverse any further growth of prevalence. Reduction in prevalence subsequently leads to reduction in costs. There are a number of organizations and policy actions that are relevant when discussing the economics of preventive care services. The evidence base, viewpoints, and policy briefs from the Robert Wood Johnson Foundation, the Organisation for Economic Co-operation and Development (OECD), and efforts by the U.S. Preventive Services Task Force (USPSTF) all provide examples that improve the health and well-being of populations (e.g. preventive health assessments/screenings, prenatal care, and telehealth/telemedicine). The Affordable Care Act (ACA) has major influence on the provision of preventive care services, although it is currently under heavy scrutiny and review by the new administration. According to the Centers for Disease Control and Prevention (CDC), the ACA makes preventive care affordable and accessible through mandatory coverage of preventive services without a deductible, copayment, coinsurance, or other cost sharing.{{cite web | title = Preventive Health Care: What is the Problem | url = https://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/preventivehealth.html | archive-url = https://web.archive.org/web/20160110135937/https://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/preventivehealth.html | archive-date = 10 January 2016 | work = U.S. Centers for Disease Control and Prevention }}

The U.S. Preventive Services Task Force (USPSTF), a panel of national experts in prevention and evidence-based medicine, works to improve health of Americans by making evidence-based recommendations about clinical preventive services.{{Cite web|title=A and B Recommendations {{!}} United States Preventive Services Taskforce|url=https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-and-b-recommendations|access-date=2021-07-05|website=www.uspreventiveservicestaskforce.org}} They do not consider the cost of a preventive service when determining a recommendation. Each year, the organization delivers a report to Congress that identifies critical evidence gaps in research and recommends priority areas for further review.{{cite web | title = U.S. Preventive Services Task Force - Annual Reports | work = U.S. Preventive Services Task Force (USPSTF) | url = https://www.uspreventiveservicestaskforce.org/Page/Name/reports-to-congress | archive-url = https://web.archive.org/web/20160310020717/https://www.uspreventiveservicestaskforce.org/Page/Name/reports-to-congress | archive-date = 10 March 2016 }}

The National Network of Perinatal Quality Collaboratives (NNPQC), sponsored by the CDC, supports state-based perinatal quality collaboratives (PQCs) in measuring and improving upon health care and health outcomes for mothers and babies. These PQCs have contributed to improvements such as reduction in deliveries before 39 weeks, reductions in healthcare associated bloodstream infections, and improvements in the utilization of antenatal corticosteroids.{{Cite web|date=2021-05-07|title=Perinatal Quality Collaboratives {{!}} Perinatal {{!}} Reproductive Health {{!}} CDC|url=https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pqc.htm|access-date=2021-07-05|website=www.cdc.gov|language=en-us}}

Telehealth and telemedicine has realized significant growth and development recently. The Center for Connected Health Policy (The National Telehealth Policy Resource Center) has produced multiple reports and policy briefs on the topic of Telehealth and Telemedicine and how they contribute to preventive services.{{cite web | title = Reports and Policy Briefs | url = http://www.telehealthpolicy.us/reports-and-policy-briefs | archive-url = https://web.archive.org/web/20170803200511/http://www.telehealthpolicy.us/reports-and-policy-briefs | archive-date = 3 August 2017 | work = Center for Connected Health Policy (CCHP) }} Policy actions and provision of preventive services do not guarantee utilization. Reimbursement has remained a significant barrier to adoption due to variances in payer and state level reimbursement policies and guidelines through government and commercial payers. Americans use preventive services at about half the recommended rate and cost-sharing, such as deductibles, co-insurance, or copayments, also reduce the likelihood that preventive services will be used. Despite the ACA's enhancement of Medicare benefits and preventive services, there were no effects on preventive service utilization, calling out the fact that other fundamental barriers exist.{{cite journal | vauthors = Jensen GA, Salloum RG, Hu J, Ferdows NB, Tarraf W | title = A slow start: Use of preventive services among seniors following the Affordable Care Act's enhancement of Medicare benefits in the U.S | journal = Preventive Medicine | volume = 76 | pages = 37–42 | date = July 2015 | pmid = 25895838 | doi = 10.1016/j.ypmed.2015.03.023 }}

The Patient Protection and Affordable Care Act, also known as just the Affordable Care Act or Obamacare, was passed and became law in the United States on March 23, 2010.{{cite journal | vauthors = Fein O | title = Keep the single payer vision | journal = Medical Care | volume = 48 | issue = 9 | pages = 759–60 | date = September 2010 | pmid = 20716995 | doi = 10.1097/mlr.0b013e3181f28be4 | jstor = 25750554 }} The finalized and newly ratified law was to address many issues in the U.S. healthcare system, which included expansion of coverage, insurance market reforms, better quality, and the forecast of efficiency and costs.{{cite journal| vauthors = Harrington SE |title=U. S. Health-care Reform: The Patient Protection and Affordable Care Act|journal=The Journal of Risk and Insurance|date=1 January 2010|volume=77|issue=3|pages=703–708|jstor=40783701|doi=10.1111/j.1539-6975.2010.01371.x|s2cid=154189813}} Under the insurance market reforms the act required that insurance companies no longer exclude people with pre-existing conditions, allow for children to be covered on their parents' plan until the age of 26, and expand appeals that dealt with reimbursement denials. The Affordable Care Act also banned the limited coverage imposed by health insurances, and insurance companies were to include coverage for preventive health care services.{{cite journal | vauthors = Rosenbaum S | title = The Patient Protection and Affordable Care Act: implications for public health policy and practice | journal = Public Health Reports | volume = 126 | issue = 1 | pages = 130–5 | date = 1 January 2011 | pmid = 21337939 | pmc = 3001814 | doi = 10.1177/003335491112600118 | jstor = 41639332 }} The U.S. Preventive Services Task Force has categorized and rated preventive health services as either A or B, as to which insurance companies must comply and present full coverage. Not only has the U.S. Preventive Services Task Force provided graded preventive health services that are appropriate for coverage, they have also provided many recommendations to clinicians and insurers to promote better preventive care to ultimately provide better quality of care and lower the burden of costs.{{cite journal | title = Health plan implementation of U.S. Preventive Services Task Force A and B recommendations--Colorado, 2010 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 60 | issue = 39 | pages = 1348–50 | date = October 2011 | pmid = 21976117 | jstor = 23320884 | author1 = Centers for Disease Control Prevention }}

Healthcare insurance companies are willing to pay for preventive care despite the fact that patients are not acutely sick in hope that it will prevent them from developing a chronic disease later on in life.{{Cite book|title=The economics of health and health care| vauthors = Folland S |publisher=Pearson Education|year=2010|location=Upper Saddle River}} Today, health insurance plans offered through the Marketplace, mandated by the Affordable Care Act are required to provide certain preventive care services free of charge to patients. Section 2713 of the Affordable Care Act,{{Cite web|title=Affordable Care Act Implementation FAQs - Set 12 {{!}} CMS|url=https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs12|access-date=2021-07-05|website=www.cms.gov}} specifies that all private Marketplace and all employer-sponsored private plans (except those grandfathered in) are required to cover preventive care services that are ranked A or B by the U.S. Preventive Services Task Force free of charge to patients.{{Cite web|url=https://complianceadministrators.com/ppaca-preventive-care-coverage-requirements/|title=ACA: Preventive Care Coverage Requirements—Compliancedashboard: Interactive Web-Based Compliance Tool|website=complianceadministrators.com|access-date=2016-03-25}}{{Cite web|url=http://kff.org/health-reform/fact-sheet/preventive-services-covered-by-private-health-plans/#endnote_link_160040-3.|title=Preventive Services Covered by Private Health Plans under the Affordable Care Act|website=kff.org|language=en-US|access-date=2016-03-25|date=2015-08-04}} UnitedHealthcare insurance company has published patient guidelines at the beginning of the year explaining their preventive care coverage.{{Cite web|url=https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20P|title=Preventative [sic] care services|website=UnitedHealthcare|access-date=March 23, 2016}}

Evaluating the incremental benefits of preventive care requires a longer period of time when compared to acutely ill patients. Inputs into the model such as discounting rate and time horizon can have significant effects on the results. One controversial subject is use of a 10-year time frame to assess cost effectiveness of diabetes preventive services by the Congressional Budget Office.{{Cite web|url=http://www.fightchronicdisease.org/sites/default/files/docs/PFCD_whitepaper5.21.09_0.pdf|title=Health-Care Cost Projections for Diabetes and other Chronic Diseases: The Current Context and Potential Enhancement.| vauthors = O'Grady M |website=Fight Chronic Disease|access-date=March 24, 2016}}

Preventive care services mainly focus on chronic disease.{{Cite web|url=https://www.cbo.gov/publication/50877|title=Estimating the Effects of Federal Policies Targeting Obesity: Challenges and Research Needs|website=Congressional Budget Office|date=26 October 2015|access-date=2016-03-25}} The Congressional Budget Office has provided guidance that further research is needed in the area of the economic impacts of obesity in the U.S. before the CBO can estimate budgetary consequences. A bipartisan report published in May 2015 recognizes the potential of preventive care to improve patients' health at individual and population levels while decreasing the healthcare expenditure.{{Cite web|url=http://bipartisanpolicy.org/wp-content/uploads/2015/05/BPC-Prevention-Prescription-Report.pdf|title=A prevention prescription for improving health and health care in America|website=Bipartisan policy center|access-date=March 24, 2016}}

Chronic diseases such as heart disease, stroke, diabetes, obesity and cancer have become the most common and costly health problems in the United States. In 2014, it was projected that by 2023 that the number of chronic disease cases would increase by 42%, resulting in $4.2 trillion in treatment and lost economic output.{{cite web | vauthors = Chatterjee A, Kubendran S, King J, DeVol R | date = February 2014 | work = Milken Institute | title = Chronic Disease and Wellness in America | url = http://assets1c.milkeninstitute.org/assets/Publication/ResearchReport/PDF/Checkup-Time-Chronic-Disease-and-Wellness-in-America.pdf | archive-url = https://web.archive.org/web/20170228113729/http://assets1c.milkeninstitute.org/assets/Publication/ResearchReport/PDF/Checkup-Time-Chronic-Disease-and-Wellness-in-America.pdf | archive-date = 28 February 2017 }} They are also among the top ten leading causes of mortality.{{cite web | title = CDC National Health Report Highlights | url = https://www.cdc.gov/healthreport/publications/compendium.pdf | work = U.S. Centers for Disease Control and Prevention }} Chronic diseases are driven by risk factors that are largely preventable. Sub-analysis performed on all deaths in the United States in 2000 revealed that almost half were attributed to preventable behaviors including tobacco, poor diet, physical inactivity and alcohol consumption. More recent analysis reveals that heart disease and cancer alone accounted for nearly 46% of all deaths.{{cite web | title = Chronic Diseases and Health Promotion | work = U.S. Centers for Disease Control and Prevention | url = https://www.cdc.gov/chronicdisease/overview/index.htm | archive-url = https://web.archive.org/web/20140302181339/https://www.cdc.gov/chronicdisease/overview/index.htm | archive-date = 2 March 2014 }} Modifiable risk factors are also responsible for a large morbidity burden, resulting in poor quality of life in the present and loss of future life earning years. It is further estimated that by 2023, focused efforts on the prevention and treatment of chronic disease may result in 40 million fewer chronic disease cases, potentially reducing treatment costs by $220 billion.

Childhood immunizations are largely responsible for the increase in life expectancy in the 20th century. From an economic standpoint, childhood vaccines demonstrate a very high return on investment. According to Healthy People 2020, for every birth cohort that receives the routine childhood vaccination schedule, direct health care costs are reduced by $9.9 billion and society saves $33.4 billion in indirect costs.{{Cite web|title=Immunization and Infectious Diseases {{!}} Healthy People 2020|url=https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases|access-date=2021-07-05|website=www.healthypeople.gov}} The economic benefits of childhood vaccination extend beyond individual patients to insurance plans and vaccine manufacturers, all while improving the health of the population.{{cite journal | vauthors = Jit M, Hutubessy R, Png ME, Sundaram N, Audimulam J, Salim S, Yoong J | title = The broader economic impact of vaccination: reviewing and appraising the strength of evidence | journal = BMC Medicine | volume = 13 | issue = 1 | pages = 209 | date = September 2015 | pmid = 26335923 | pmc = 4558933 | doi = 10.1186/s12916-015-0446-9 | doi-access = free }}

The burden of preventable illness extends beyond the healthcare sector, incurring costs related to lost productivity among workers in the workforce. Indirect costs related to poor health behaviors and associated chronic disease costs U.S. employers billions of dollars each year.{{citation needed|date=June 2022}}

According to the American Diabetes Association (ADA),{{cite journal | title = Economic costs of diabetes in the U.S. in 2012 | journal = Diabetes Care | volume = 36 | issue = 4 | pages = 1033–46 | date = April 2013 | pmid = 23468086 | pmc = 3609540 | doi = 10.2337/dc12-2625 | author1 = American Diabetes Association }} medical costs for employees with diabetes are twice as high as for workers without diabetes and are caused by work-related absenteeism ($5 billion), reduced productivity at work ($20.8 billion), inability to work due to illness-related disability ($21.6 billion), and premature mortality ($18.5 billion). Reported estimates of the cost burden due to increasingly high levels of overweight and obese members in the workforce vary,{{cite journal | vauthors = Goettler A, Grosse A, Sonntag D | title = Productivity loss due to overweight and obesity: a systematic review of indirect costs | journal = BMJ Open | volume = 7 | issue = 10 | pages = e014632 | date = October 2017 | pmid = 28982806 | pmc = 5640019 | doi = 10.1136/bmjopen-2016-014632 }} with best estimates suggesting 450 million more missed work days, resulting in $153 billion each year in lost productivity, according to the CDC Healthy Workforce.{{Cite web|title=Business Pulse Series {{!}} CDC Foundation|url=http://www.cdcfoundation.org/businesspulse-series|access-date=2021-07-05|website=www.cdcfoundation.org|language=en}}

The health capital model explains how individual investments in health can increase earnings by "increasing the number of healthy days available to work and to earn income."Folland, S., Goodman, A.C., & Stano, M. (2016). Demand for Health Capital. The Economics of Health and Healthcare, 7th ed. (p. 130). New York, NY: Routledge. In this context, health can be treated both as a consumption good, wherein individuals desire health because it improves quality of life in the present, and as an investment good because of its potential to increase attendance and workplace productivity over time. Preventive health behaviors such as healthful diet, regular exercise, access to and use of well-care, avoiding tobacco, and limiting alcohol can be viewed as health inputs that result in both a healthier workforce and substantial cost savings.{{citation needed|date=July 2021}}

Health benefits of preventive care measures can be described in terms of quality-adjusted life-years (QALYs) saved. A QALY takes into account length and quality of life, and is used to evaluate the cost-effectiveness of medical and preventive interventions. Classically, one year of perfect health is defined as 1 QALY and a year with any degree of less than perfect health is assigned a value between 0 and 1 QALY.{{cite journal | vauthors = Neumann PJ, Cohen JT | title = Cost savings and cost-effectiveness of clinical preventive care | journal = The Synthesis Project. Research Synthesis Report | volume = | issue = 18 | pages = | date = September 2009 | pmid = 22052182 | doi = | url = https://www.rwjf.org/content/dam/farm/reports/issue_briefs/2009/rwjf46045 }} As an economic weighting system, the QALY can be used to inform personal decisions, to evaluate preventive interventions and to set priorities for future preventive efforts.{{citation needed|date=July 2021}}

Cost-saving and cost-effective benefits of preventive care measures are well established. The Robert Wood Johnson Foundation evaluated the prevention cost-effectiveness literature, and found that many preventive measures meet the benchmark of <$100,000 per QALY and are considered to be favorably cost-effective. These include screenings for HIV and chlamydia, cancers of the colon, breast and cervix, vision screening, and screening for abdominal aortic aneurysms in men >60 in certain populations. Alcohol and tobacco screening were found to be cost-saving in some reviews and cost-effective in others. According to the RWJF analysis, two preventive interventions were found to save costs in all reviews: childhood immunizations and counseling adults on the use of aspirin.{{Cite web|date=2009-09-01|title=Cost Savings and Cost-Effectiveness of Clinical Preventive Care|url=https://www.rwjf.org/en/library/research/2009/09/cost-savings-and-cost-effectiveness-of-clinical-preventive-care.html|access-date=2021-07-05|website=RWJF|language=en}}

Health disparities are increasing in the United States for chronic diseases such as obesity, diabetes, cancer, and cardiovascular disease. Populations at heightened risk for health inequities are the growing proportion of racial and ethnic minorities, including African Americans, American Indians, Hispanics/Latinos, Asian Americans, Alaska Natives and Pacific Islanders.{{cite web | title = The Economic Case for Health Equity | work = Association of State and Territorial Health Officials | location = Arlington, VA | url = http://www.astho.org/Programs/Health-Equity/Economic-Case-Issue-Brief/}}

According to the Racial and Ethnic Approaches to Community Health (REACH), a national CDC program, non-Hispanic blacks currently have the highest rates of obesity (48%), and risk of newly diagnosed diabetes is 77% higher among non-Hispanic blacks, 66% higher among Hispanics/Latinos and 18% higher among Asian Americans compared to non-Hispanic whites. Current U.S. population projections predict that more than half of Americans will belong to a minority group by 2044.{{cite web| vauthors = Colby SL, Ortman JM |date=March 2015|url=https://census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.pdf|title=Projections of the Size and Composition of the U.S. Population: 2014–2060|work=Current Population Reports|publisher=United States Census Bureau|pages=25–1143|access-date=5 July 2021}} Without targeted preventive interventions, medical costs from chronic disease inequities will become unsustainable. Broadening health policies designed to improve delivery of preventive services for minority populations may help reduce substantial medical costs caused by inequities in health care, resulting in a return on investment.{{citation needed|date=July 2021}}

{{See also|Health policy}}

Chronic disease is a population level issue that requires population health level efforts and national and state level public policy to effectively prevent, rather than individual level efforts. The United States currently employs many public health policy efforts aligned with the preventive health efforts discussed above. The Centers for Disease Control and Prevention support initiatives such as Health in All Policies and HI-5 (Health Impact in 5 Years), and collaborative efforts that aim to consider prevention across sectors{{Cite web|date=2019-06-18|title=Health in All Policies {{!}} AD for Policy and Strategy {{!}} CDC|url=https://www.cdc.gov/policy/hiap/index.html|access-date=2021-07-05|website=www.cdc.gov|language=en-us}} and address social determinants of health as a method of primary prevention for chronic disease.{{Cite web|date=2019-07-01|title=Health Impact in 5 Years {{!}} Health System Transformation {{!}} AD for Policy {{!}} CDC|url=https://www.cdc.gov/policy/hst/hi5/index.html|access-date=2021-07-05|website=www.cdc.gov|language=en-us}}

Policies that address the obesity epidemic should be proactive and far-reaching, including a variety of stakeholders both in healthcare and in other sectors. Recommendations from the Institute of Medicine in 2012 suggest that "concerted action be taken across and within five environments (physical activity (PA), food and beverage, marketing and messaging, healthcare and worksites, and schools) and all sectors of society (including government, business and industry, schools, child care, urban planning, recreation, transportation, media, public health, agriculture, communities, and home) in order for obesity prevention efforts to truly be successful."{{cite journal | vauthors = Chriqui JF | title = Obesity Prevention Policies in U.S. States and Localities: Lessons from the Field | journal = Current Obesity Reports | volume = 2 | issue = 3 | pages = 200–210 | date = September 2013 | pmid = 24511455 | pmc = 3916087 | doi = 10.1007/s13679-013-0063-x }}

There are dozens of current policies acting at either (or all of) the federal, state, local and school levels. Most states employ a physical education requirement of 150 minutes of physical education per week at school, a policy of the National Association of Sport and Physical Education. In some cities, including Philadelphia, a sugary food tax is employed. This is a part of an amendment to Title 19 of the Philadelphia Code, "Finance, Taxes and Collections", Chapter 19-4100, Sugar-Sweetened Beverage Tax that was approved 2016, which establishes an excise tax of $0.015 per fluid ounce on distributors of beverages sweetened with both caloric and non-caloric sweeteners.{{cite web | title = Chapter 19-4100. Sugar-Sweetened Beverage Tax. | work = City of Philadelphia | url = https://beta.phila.gov/media/20170209150802/CertifiedCopy16017601-1.pdf}} Distributors are required to file a return with the department, and the department can collect taxes, among other responsibilities. These policies can be a source of tax credits. Under the Philadelphia policy, businesses can apply for tax credits with the revenue department on a first-come, first-served basis. This applies until the total amount of credits for a particular year reaches one million dollars.{{Cite web|last=smithaa02|date=2017-11-13|title=Philadelphia, Penn., Code tit Chapter 19-4100 (current through Nov. 7, 2017)|url=https://healthyfoodpolicyproject.org/policy/philadelphia-penn-code-tit-chapter-19-4100-current-through-nov-7-2017|access-date=2021-07-05|website=Healthy Food Policy Project|language=en}}

Recently, advertisements for food and beverages directed at children have received much attention. The Children's Food and Beverage Advertising Initiative (CFBAI) is a self-regulatory program of the food industry. Each participating company makes a public pledge that details its commitment to advertise only foods that meet certain nutritional criteria to children under 12 years old.{{Cite web|title=Children's Food & Beverage Advertising Initiative|url=https://bbbprograms.org/programs/all-programs/cfbai|access-date=2021-07-05|website=BBBPrograms|language=en}} This is a self-regulated program with policies written by the Council of Better Business Bureaus. The Robert Wood Johnson Foundation funded research to test the efficacy of the CFBAI. The results showed progress in terms of decreased advertising of food products that target children and adolescents.{{cite web | title = Trends in Television Food Advertising to Young People: 2016 Update | date = June 2017 | work = Rudd Center for Obesity Food Policy | publisher = University of Connecticut | url = http://www.uconnruddcenter.org/files/TVAdTrends2017.pdf}}

Despite nationwide controversies over childhood vaccination and immunization, there are policies and programs at the federal, state, local and school levels outlining vaccination requirements. All states require children to be vaccinated against certain communicable diseases as a condition for school attendance. However, only 18 states allow exemptions for "philosophical or moral reasons." Diseases for which vaccinations form part of the standard ACIP vaccination schedule are diphtheria tetanus pertussis (whooping cough), poliomyelitis (polio), measles, mumps, rubella, haemophilus influenzae type b, hepatitis B, influenza, and pneumococcal infections.{{Cite web|title=State Mandates on Immunization and Vaccine-Preventable Diseases|url=https://www.immunize.org/laws/|access-date=2021-07-05|website=www.immunize.org}} The CDC website maintains such schedules.{{Cite web|date=2021-06-16|title=Birth-18 Years Immunization Schedule {{!}} CDC|url=https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html|access-date=2021-07-05|website=www.cdc.gov|language=en-us}}

The CDC website describes a federally funded program, Vaccines for Children (VFC), which provides vaccines at no cost to children who might not otherwise be vaccinated because of inability to pay. Additionally, the Advisory Committee on Immunization Practices (ACIP) is an expert vaccination advisory board that informs vaccination policy and guides on-going recommendations to the CDC, incorporating the most up-to-date cost-effectiveness and risk-benefit evidence in its recommendations.{{Cite web|date=2021-07-01|title=Advisory Committee on Immunization Practices (ACIP) {{!}} CDC|url=https://www.cdc.gov/vaccines/acip/index.html|access-date=2021-07-05|website=www.cdc.gov|language=en-us}}

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• Urban green space#Impact on health
• Chemoprevention
• Consumer protection
• Effects of climate change on human health
• Health security
• Genetic modifications preventing diseases
• Epigenetics
• Mental illness prevention
• Pandemic prevention
• Public health
• Pre-exposure prophylaxis
• Preparedness
• Preventive and social medicine
• Primary Health Care
• Pollution prevention (disambiguation)
• Sick building syndrome
• Treatment as prevention

Journals and organizations

• American Board of Preventive Medicine
• American Journal of Preventive Medicine
• American Osteopathic Board of Preventive Medicine
• Preventive Medicine (journal)

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{{reflist}}

• [http://www.uspreventiveservicestaskforce.org/ United States Preventive Services Task Force (USPSTF)]
• [https://canadiantaskforce.ca/ Canadian Task Force on Preventive Health Care (CTFPHC)]
• [http://www.ecdc.europa.eu/en/Pages/home.aspx European Centre for Disease Prevention and Control (ECDC)]
• {{cite web |editor1-last=Hu |editor1-first=Frank |editor2-last=Cheung |editor2-first=Lilian |editor3-last=Otis |editor3-first=Brett |editor4-last=Oliveira |editor4-first=Nancy |editor5-last=Musicus |editor5-first=Aviva |date=19 January 2021 |url=https://www.hsph.harvard.edu/nutritionsource/2021/01/19/healthy-living-guide-2020-2021/ |url-status=live |title=The Nutrition Source – Healthy Living Guide 2020/2021: A Digest on Healthy Eating and Healthy Living |website=www.hsph.harvard.edu |location=Boston |publisher=Department of Nutrition at the Harvard T.H. Chan School of Public Health |archive-url=https://web.archive.org/web/20211005072821/https://www.hsph.harvard.edu/nutritionsource/2021/01/19/healthy-living-guide-2020-2021/ |archive-date=5 October 2021 |access-date=11 October 2021}}

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Category:Medical terminology

Category:Nursing specialties