A sketch on a napkin: visualizing the U.S. Prevention System
There has been a lot of attention on the question of evolving the patchwork of systems we now have for health care in the U.S. into a more rational and coherent single system. As we strain to visualize a more functional future U.S. Health Care System, maybe we should also take a stab at more specifically designing the U.S. Prevention System.
Clearly, the health care system has a role in prevention, but without more attention to defining a prevention system there is risk that too much prevention focus will be on health care system issues. Nobody wants to use the health care system, really, and a Prevention System can be messaged as the proverbial apple-a-day. A highly-functioning prevention system necessarily includes health care, of course, but is much more than health care. A more explicit effort to better envision and better define a Prevention System would highlight the counterweight function of prevention versus health care.
Envisioning a System is a little like designing the Space Shuttle in 1970: the general idea of a re-usable winged craft that could deliver both people and cargo into and out of space was there, but just what it would look like took some engineering. The engineering for a US Prevention System will need to evolve in the coming years with wide input, but the general idea of the need for this engineering is what I am calling for now. Below is my brief sketch, essentially the Space Shuttle on a napkin.
The current prevention system includes efforts by health care and public health organizations that include government at all levels, all health care systems, private business interests, NGOs, and lots of individuals with strong opinions about how to stay well. The US Prevention System of the future will contain all of these same elements, but drawn out clearer so that the various elements know their roles better, and so that the connectors between the elements can be more strategically defined and better supported. My sketch on the napkin would start with the organizations and boxes we now have (CDC, PH agencies, HC system, NGOs) and identify those places (connections) where better collaboration can produce better results based on evidence we now have. The roles for direct services vs education and policy would be more clearly drawn in a rational prevention system.
Who would lead this system? I am not sure. CDC is the logical lead agency, so perhaps the CDC Director, but maybe we would be better off with a new federal position for prevention, akin to the Surgeon General (Prevention General), but not part of the PHS structure. As you can see, systems visualization gets muddy in the weeds. I think that is all the detail I should draw right now. The general idea is for more intentional visioning and better systems for a future U.S. Prevention System that could deliver more effective prevention in the future that includes, but is much more than, the hoped-for U.S. Health Care System.