The New York Times (NYT) last week published an article asserting that preventive care measures cost money and do not lead to reduced health care expenses over time. As a leader in promoting preventive measures like physical activity and its cobenefits, the American College of Sports Medicine disagrees with the author’s opinion in the article. On behalf of members, advocates and other stakeholders, ACSM submitted a response to NYT editors that shares the college’s position on the issue. The focus of the ACSM response is that sound programs have a profound ability to improve health, prevent disease, and avoid premature deaths, and moderate increases in physical activity can improve physical fitness and quality of life, while costing nothing.

ACSM President Walt Thompson’s response to The New York Times:

The article by Aaron E. Carroll, “Preventive Care Saves Money? Sorry, It’s Too Good to Be True” on the possible cost effectiveness of disease prevention measures makes a good point -- not all prevention efforts work, not all are cost-effective, and not all are based soundly in science and best practice.  But prevention efforts that work can be powerful, and can cost little or even nothing!  For instance, simply adopting a more active lifestyle by walking more can decrease high blood pressure and heart disease development. Lifestyle counseling can be highly effective in preventing type 2 diabetes, especially in high-risk adults. A powerful example: The Diabetes Prevention Program (DPP) for Medicare enrollees has identified a savings of $2,650 over 18 months for those enrolled in the DPP compared to matched members who did not enroll in the program. The DPP is a profound demonstration of the cost effectiveness of prevention through healthy lifestyle interventions around diet and physical activity.  Further, intensive clinical programs to improve fitness through exercise can reverse heart disease.  Workplace health promotion programs can improve health behaviors and health conditions.  Strength training programs can reduce the risks of older adults falling and sustaining severe or even fatal injury.

Not all prevention programs are well-designed, implemented by professionals with the needed training and expertise, with the necessary community support to sustain them.  But sound programs have a profound ability to improve health, prevent disease, and avoid premature deaths.  Even moderate increases in physical activity such as taking the stairs instead of the elevator, walking instead of riding, or doing simple strengthening can improve physical fitness and quality of life. These changes cost nothing! 

Most medical spending in the US is tied to chronic diseases. Many of those diseases are associated with tobacco use, poor diet, and physical inactivity.  The American College of Sports Medicine’s Exercise is Medicine® initiative supplies health care providers with tools to help their patients achieve adequate activity to prevent the onset of diseases related to sedentary lifestyles. It works, it’s inexpensive, and it can make a major difference in a person’s health. Not all prevention efforts produce cost savings, but do yield other benefits important to individuals and American society. And some prevention initiatives, like the Diabetes Prevention Program, produce extraordinary cost effectiveness. To abandon or discount continuing progress in prevention efforts is not only unwise, it actually will doom the American economy. According to the Congressional Budget Office’s long-term budget scenarios, the economy can’t grow enough to cover the rising costs of treating people with preventable diseases, especially diseases related to lifestyle and health habits. Does well-designed preventive care save money?  Yes.  Can we afford (literally) to ignore that fact?  No. 

Preventive care saves money?  Happily, it CAN!

Walt Thompson, President
American College of Sports Medicine