Boyle Heights

This blog is co-authored by Prevention Institute’s Executive Director Larry Cohen and The Endowment’s Senior Vice President Anthony Iton, MD, MPH.

The Institute for Medicine today published a discussion paper and call to action authored by the Prevention Institute’s Larry Cohen and Dr. Anthony Iton, senior vice president of The California Endowment. The paper, Closing the Loop: Why We Need to Invest—and Reinvest—in Prevention, is aimed at catalyzing conversation about how health care and prevention are paid for. Read the full paper here.

There’s a growing consensus among policymakers and health planners that if we want to improve health outcomes and lower costs we must change community conditions in ways that support health and prevent illness and injury before they occur. In their article, Larry and Tony make the case for the creation of sustainable funding mechanisms that support prevention efforts. They argue that we need to “close the loop” by ensuring that when prevention efforts DO save money, substantial portions of that money get plowed back into prevention.

The Closing the Loop concept relates to a model that Prevention Institute has been developing called Community-Centered Health Homes. It encourages healthcare providers to engage with their community to improve local conditions that affect health, as well as delivering high-quality care.

The following is drawn from the IOM article:

What would you do if an investment you made returned 5,500 percent? You’d probably look for ways to reinvest most of it.

From 1989 to 2008, the state of California invested $2.4 billion from cigarettes taxes and into the California Tobacco Control Program, which spent the money on efforts to reduce smoking—from helping community coalitions pursue no-smoking policies to underwriting media campaigns. The $2.4 billion investment saved $134 billion—that’s the 5,500 percent return—from reduced medical expenditures that would otherwise have been needed to treat smoking-related illness, a UC San Francisco analysis found.

I (Larry Cohen) worked on the nation’s first multicity no-smoking laws, and I’m proud we reduced smoking, saved lives, and changed norms. This return on investment is great but it raises a question: Given how fruitful the investment, why hasn’t more money been devoted to prevention? Very little of the $134 billion in savings—or of the millions raised from legal settlements with tobacco companies—has gone into further efforts to prevent smoking.

I (Tony Iton) am a physician who worked successfully to ban smoking in bars and restaurants in Connecticut and now works to reduce the shocking and preventable life-expectancy differences among California neighborhoods. The health challenges we now face require us to apply the vast prevention knowledge we’ve acquired. We don’t have to wait for people to become sick before we act.

We believe it’s time to close the loop to ensure that two things happen. First, when funds are generated through taxes, fees, or fines connected to behaviors such as smoking, driving, or drinking, a major portion of that revenue should go to reducing the harms that stem from those activities. Second, when prevention efforts are shown to save money, a substantial part of that bounty should be reinvested in prevention. Think of the money and lives that could be saved if a significant piece of the $134 billion saved by tobacco-control efforts went to reduce tobacco use among young people or in communities where smoking rates remain high.

Health care expenditures cost our nation $2.8 trillion a year and account for one of every six dollars of GDP. There is a growing consensus that if we want to reduce health care spending, we must reduce rates of preventable conditions that drive that spending. To do that, we need new funding models that incentivize prevention within our health care system and support community-level prevention efforts.

Here are the key elements of a Closing the Loop strategy:

•    Startup: Make initial investments to support major initiatives—such as California’s tobacco-control efforts. Revenue could come from taxes on tobacco, alcohol, soda, junk food or legal marijuana, as well as philanthropy, hospital community-benefits programs and license-plate fees.

•    Recapture: Establish mechanisms for tracking money saved by health care providers and insurers and reinvest a substantial portion.

•    Reinvest: Establish a participatory reinvestment process, based on agreed-upon criteria and strategies that promote health and wellness, further reducing costs and savings lives.

This is what a true System of Prevention might look like:

As a young Chicano, it is rather difficult to find Latinos in leading professions. The weekend of the National Council of La Raza (NCLR) conference proved to me that there are Latinos breaking ground and paving the way for future generations. As an invited guest from The California Endowment, I attended Dr. Robert K. Ross’s and Dr. Beatriz Solis’s presentation among other sessions. I like how The California Endowment gathered positive messages for the Central American children refugees. As Dr. Ross said, these children need to be cared for properly. This act of kindness from The Endowment is truly commendable; it makes me like The Endowment even more. The NCLR conference had many great speeches during the four-day event, words of inspiration that I carry with me.

The Endowment’s President & CEO Robert K. Ross presenting at the 2014 NCLR Conference.

The first session I went to was one that focused on Latinos in politics. In this session the panel consisted of former Mayor Antonio Villaraigosa, Monica Garcia, Alex Padilla, and Nury Martinez. As a young adult I aspire to be a public servant for my community of Boyle Heights. This session definitely inspired me after hearing more about Mayor Villaraigosa’s story. Like me he attended Roosevelt High School and went on to go to East Los Angeles College, and finally to UCLA. It’s remarkable that my path is the same as Mayor Villaraigosa’s. His story further solidifies my passion for public service, and the notion that it really does not matter what path you take as long as one finishes at the same destination. Perhaps I too can become Mayor of Los Angeles one day.

I also sat in on a STEM workshop. Although it is not my career path, I listened to the panel and later told my friends about the new information I received. The information included an amazing documentary, Underwater Dreams, in which undocumented Mexican immigrant high school students enter a robotics competition and ultimately win, beating the likes of MIT students. The sessions provided many Latino role models, most of which had backgrounds similar to mine.

The conference had some amazing events going on throughout the day; so much that it was difficult to attend them all. One of the highlights of the conference was the Family Expo that was open to the Latino community. It was here that I took plenty of pictures promoting the #Health4All campaign. While taking pictures, I went to all the booths until I stumbled upon the CVS mobile clinic. In my BHC site of Boyle Heights, it is important that members of my community have health screenings, so I decided to take up CVS’s offer and take a free health screening. My results were positive as I received good news regarding my health.

Luis Melchor and friends posing for the camera with the #Health4All pin drop.

The Family Expo also had raffles, many of which I participated in, but lost. However, I still walked away with many cool goodies from the many booths. I continued to walk around the Expo taking pictures with the #Health4All pin drop and explaining the campaign to people. Like many BHC sites across California, it is important in my community that everyone has health insurance. No one should be denied. Members who are undocumented deserve to have quality health insurance to help protect them should they get sick. The #Health4all campaign is an ongoing battle, but reaching the goal is not impossible. The campaign will help lift the voices of the disenfranchised and catalyze action to ensure all Californians have access to health coverage and care.

Luis and other youth leaders promoting the #Health4All campaign.

The best part of the conference was the stellar lunches and dinner, not only because of the savory food, but the strong, passionate speeches given. Janet Murguia delivered an amazing speech, filled with passion, addressing many concerns regarding our nation, which included the humanitarian crisis at the border. My favorite speech of the conference belonged to Kamala Harris, a hero of mine. I truly admire her strong dedication to serving the public and going beyond her duties. I wish I can someday be half the person she is. This conference was very special to me; I was able to meet individuals at the top of their respective professions and the best part was that these individuals looked just like me! Latinos in this nation hold tremendous influence in shaping the future. I am grateful to The California Endowment for giving me so many life-changing opportunities.