The USA spends $3.8 trillion on health care annually, of which, 90% is for chronic disease management. Adverse childhood events increase the number of adults living with chronic disease. The largest component for the decrease in prevalence of smokers is fewer new smokers, due to public awareness campaign to prevent children from starting to smoke. This just illustrates how investing in prevention can reduce downstream costs. We just have to make sure the government keeps its hands off my medicare. (pre-emptive “just kidding”)
A recent report in the American Economic Review found that “Early childhood Medicaid eligibility reduces mortality and disability, increases employment, and reduces receipt of disability transfer programs up to 50 years later. Medicaid has saved the government more than its original cost and saved more than 10 million quality adjusted life years.”
From this article in the lancet “Even a modest 10% reduction in the prevalence of individuals with single or multiple ACEs in both regions could be equivalent to annual savings of $105 billion (3 million DALYs). Evidence-based approaches to prevent ACEs are available, including programs to detect and support families at risk. For those experiencing ACEs, interventions to improve parenting skills, to strengthen parent–child attachment, and to develop children’s resilience can help to moderate the harmful effects of ACEs. However, advocacy for investment in such programs rarely factors in the long-term benefits to mental health and NCD prevention. Consequently, they underestimate their potential return on investment and strategic appeal.”
THERE ARE NO BOUNDARIES IN NATURE! Humans impose categories on the world as is convenient or useful. There is JUST LIFE. Then there are they ways we talk about life: health, education, development, wellbeing, careers, etc. We NEED to blur the line between what is in the domain of medicine, education, and public health. Imagine if Medicaid covered behavioral coaches for children with ADHD, tutors for children with differing learning needs.