Health Reform and Prevention: Show Us the Money!

Surgeon General Regina Benjamin got an earful today from participants in a conference call unveiling a high-level prevention council and strategy called for in the new health reform law.

On the surface, callers from advocacy groups, the military, local public health departments and industry associations publicly vowed support for the new "National Prevention, Health Promotion and Public Health Council" and the fledgling "National Prevention and Health Promotion Strategy."

But there was an undercurrent of "what's in it for us?" – and that's where you're going to find some interesting issues and controversies as the Surgeon General and many other officials try to move the public from "a system of sick care to a system of wellness and prevention," as Benjamin put it in her opening remarks.

Here are five issues to keep an eye on as health reform's national prevention work gets underway.

1. Show us the money. Here's what a small-town public health director from Ohio told the surgeon general:

"My public health department – like so many others – have seen reductions in money and services. Our importance was highlighted during last year's H1N1 (crisis). But the day-to-day prevention that we've tried so hard to do – it's not billable, not reimbursable, and we often find ourselves running very hard and not being able to accomplish what we'd like to."

The director asked pointedly: what kind of funding can we expect? That's a question you should be asking, too, as local and state health agencies seek stimulus and health reform grant money in the coming months.

2. Workplace wellness. Some large corporations are advocating for a loosening of restrictions on genetic and family medical history data to better reach employees with wellness and disease management programs.  In the conference call, Benjamin held the line on patient privacy - but it will be interesting to how that line might shift to encourage more aggressive prevention efforts. Also, most workplace wellness efforts occur in very large corporations. Will there be money for similar programs in small and medium-size businesses?

3. An emphasis on the community, not just the individual. One of the national strategy's goals is to "create community environments that make the healthy choice the easy and affordable choice." So there will be attention to, and money for, programs to eliminate food deserts, improve environmental health and address urban and domestic violence.

4. Healthy People 2020. How will the new prevention council and national strategy sync with the existing Healthy People 2020 prevention initiative? Will there be bureaucratic and funding overlap that's confusing to local agencies applying for grants? The new 2020 goals are supposed to be released by the end of the year, Benjamin said.

5. Prevention for "hidden" populations. Prevention programs for prisoners and parolees don't get much attention (or funding), but they're important, one advocate told Benjamin. The same goes for the military and V.A. patients, where the health focus tends to be on treatment for disease and war-related injury.