A $500 Million Conundrum

Health and Human Services Secretary Kathleen Sebelius has a dilemma: how to spend $500 million before the end of the year. The funds are part of the new healthcare reform package – earmarked specifically for prevention programs.

It’s common sense that prevention helps reduce long-term health costs by deterring or minimizing onset and severity of diseases. Dozens, if not hundreds, of advocacy groups are hoping for a piece of the budget pie – for community outreach programs, creating more park space and bike paths, education, awareness, screening…

With so much need, that $500 million suddenly seems like it won’t go all that far. How does the Secretary decide which programs or efforts are worthy?

Tobacco control advocates have a novel idea: take all, or at least most of the money and go all out on smoking cessation and prevention efforts. The CEO of Partnership for Prevention Robert Gould, argues that this approach makes sense from many angles – evidence-based data and proven programs already exist; there will be a huge ROI, and “tobacco use remains our leading preventable cause of premature death. It kills over 400,000 Americans a year, drives huge increases in chronic disease rates and $96 billion in health care costs”

He recommends targeting disadvantaged populations and young people – two groups that tobacco companies regularly pursue. Additionally, he points out that much of the ground work, such as smoking quit lines and community based cessation programs are already in place, therefore, can be easily replicated or expanded.

It’s a bold and novel idea. Tobacco still kills hundreds of thousands of people each year. More than heart disease, breast cancer, or diabetes. Does it make sense to go “all in” on one massive effort?

Maybe. Maybe it’s time for a different approach.It’s an interesting idea, to say the least.

It’s something the Secretary will have to consider, and quickly. $500 million is a lot of money. Until it isn’t.

If you had half a billion dollars to spend on health prevention, what would you do?


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