How Much Prevention "Stuff" Does Wisconsin Need?

By David A. Kindig, MD, PhD

Well, Wisconsin is back in the national news this week, with the refusal of our State Department of Health Services to support $28 million in federal grant applications from organizations like the Milwaukee Health Department for chronic disease prevention programs aimed at smoking and diabetes. The Department Secretary is quoted as saying “Why are we asking for taxpayer money for stuff we are already doing….this is stuff that goes on all the time.”

Perhaps he is wishing he hadn’t said that, because there is no evidence based case that can be made for not increasing our support for such public health and prevention programs. The “stuff” that we have way too much of is not prevention but the high health care costs that result from such chronic diseases. Resolution of federal and state budgets will require effectively addressing this issue; we have to spend much more on prevention to reduce the mortality and morbidity burden that has health care budgets skyrocketing and contributing substantially to the national debt.

This is a national problem, but could it be that Wisconsin is so healthy that we don’t need the resources? Nope. Our state ranks 31^st in smoking rates, 34th in obesity, and if you can believe this, 48^th in public health funding. The latter ranking is due in part to the historical lack of state funding for local public health, which makes federal dollars all the more important in Wisconsin.

We strive to make this blog a forum for ideas that are moderate, non-partisan, and evidence-informed. In writing about the Wisconsin budget process earlier this year, I noted the difficulty of sorting out “which proposals are primarily ideological and political and which are pragmatic ‘least bad’ choices.”  Unless the proposals have substantive flaws which have not been revealed, it strains credulity to believe that the state’s refusal to endorse these applications is not primarily ideological. It can’t be defended from a federal cost saving perspective since Wisconsin’s loss will be another state’s gain. It is also not compatible with the state’s critical job creation agenda which is threatened by increasing health care costs for employers due to in large part to adverse outcomes from preventable chronic diseases.

One reporter has noted that Governor Walker opposes federal health care reform, and that some states have been criticized for accepting federal health care dollars while opposing reform. However, the state has accepted a $37 million health care reform grant to design insurance exchanges, so the decision rules either aren’t consistent or need clarification. It would be very unfortunate if the decision to not apply for the chronic disease funds reflects a perspective that government has no role or responsibility in improving the health of communities through public health and prevention programs.

Perhaps state officials will decide to reverse this decision, or perhaps Secretary Sibelius will grant Milwaukee’s request to waive the requirement for a letter of state support. Or perhaps the funds will go to other states that understand what is really needed to reduce the health care burden and costs that are strangling both the public and private sectors.

David A. Kindig, MD, PhD is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health.

Comments

[Robert Stone Newsom, PhD]

Amen to that Dave: glad to see that this blogs usual 'outside the fray' academic neutrality finds that "...it strains credulity to believe that the state’s refusal to endorse these applications is not primarily ideological."

[Christine Harden, OD]

Powerful STUFF. Thank you for this incredible post. Comprehensive, succinct, eloquent, plain-spoken, and jaw-dropping.