Health and Well-Being Matter is the monthly blog of the Director of the Office of Disease Prevention and Health Promotion.
Clinical preventive services (CPS) play an integral role in protecting and promoting individual health and the health of communities. Such services can help people recognize health problems early, when treatment often is most effective. CPS can also help prevent certain diseases altogether. However, despite the benefits, very few people in the United States receive all recommended preventive services and many access few. As public health professionals, we have a responsibility to not just deliver the message about the critical role that CPS play in supporting good health, but also work to expand CPS access in whatever ways we can.
Healthy People data show a clear decline in uptake of CPS. In 2015 only 8.5 percent of adults age 35 years and older received all recommended high-priority CPS, and that number fell to a mere 5.3 percent in 2020. Additionally, in the 2016–2017 survey period, 78.7 percent of adolescents ages 12 to 17 years had 1 or more preventive health care visits in the previous 12 months, but that number dropped to 69.6 percent in the 2020–2021 survey period.
As I’ve noted in other posts, the COVID-19 pandemic exacerbated the problem — particularly because of generally prolonged periods of severely curtailed access to clinical services — but it didn’t and doesn’t account for the whole story. Other chronic barriers include lack of awareness about what preventive services are recommended and myriad social determinants such as cost, not having a primary care provider, living too far from providers, or lacking adequate transportation — just to name a few. To improve access to CPS at population scales, we must recognize and address the many variables that affect people’s awareness of such services and increase their willingness and ability to seek them.
The lack of awareness about recommended preventive services is true of laypeople and providers alike. Clinicians and non-clinicians can get the latest information about recommended CPS from the United States Preventive Services Task Force (USPSTF) website. (There’s even an app for that!) USPSTF is “an independent, volunteer panel of national experts in disease prevention and evidence-based medicine.” It reviews the most current evidence on preventive services -- including screening tests, counseling services, and preventive treatments – and uses that science to make new recommendations about CPS or to update existing CPS recommendations. Professionals can browse information or sign up for updates on USPSTF activities.
To better inform the public about needed CPS, ODPHP developed MyHealthfinder, a prevention and wellness resource that health professionals can recommend to individuals and families. MyHealthfinder includes easy-to-read, evidence-based, actionable health information in English and Spanish about almost 100 prevention and wellness topics. It also features a tool that people can use to get personalized recommendations for CPS. In addition, health professionals can add free MyHealthfinder content to their websites and help share evidence-based health information with people who need it most.
For many people cost and access pose significant hurdles to receiving preventive care. In early 2023 the national uninsured rate reached an all-time low of 7.7 percent, and while that’s good news, it still means that more than 25 million people across the nation aren’t benefiting from the Affordable Care Act (ACA) provision to cover essential preventive services. Most health plans must cover a set of essential preventive services at no cost to the patient. These services include vaccines and screening tests. Likewise and with some exceptions, Medicare and Medicaid offer similar provisions to beneficiaries. Helping Americans find affordable and accessible preventive care options is imperative if we want to mitigate a potentially enormous disease burden with exponential human and economic impacts.
Because finding and understanding coverage options can be difficult, the ACA established the Navigator program. Navigators are trained individuals or organizations that can help consumers and small businesses find coverage that’s right for them through the ACA Marketplace. Consumers of Navigator services can be confident that Navigators are unbiased and that their services are free. To find a local Navigator, simply enter a city and state name or ZIP code into the Navigator online tool, and it will populate a list of Navigators in that area.
Finally, I can never stress enough how important it is to focus on mitigating other inequities in social determinants of health (SDOH). SDOH are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. SDOH are our life circumstances, and they impact our health in innumerable ways.
While improving health literacy and ensuring coverage for CPS will help increase the severely low rates of CPS uptake, structural inequities will continue to create overwhelming obstacles to access. Overcoming these obstacles will take partnership and collaboration with a focus on dismantling inequities — to ensure, for example, that all people can get a quality education, earn livable wages, and access reliable transportation. Notably, community engagement and flexing civic muscle to help alleviate inequities in CPS access are essential means to effect change.
Fostering a culture of health promotion and disease prevention, particularly at a level of trusted community, simply makes good sense. The inconvenience and cost of a routine doctor’s appointment are nothing compared to the potentially debilitating, costly, and time-consuming effects of a preventable condition. The momentary pain from the stick of a needle is a small investment that offers a big return in the form of disease prevention. The cost and time invested in getting screening tests can lead to lab results that may convey important information about one’s personal health. Having a conversation with a friend or a loved one and encouraging them to seek preventive care services only takes a few moments but may literally make a lifetime of difference. We all have a role to play — as individuals and as communities — in promoting uptake of clinical preventive services. Prevention truly is the best medicine. Or perhaps I should say prevention is better than any medicine.
Yours in health,
Paul Reed, MD
Rear Admiral, U.S. Public Health Service
Deputy Assistant Secretary for Health
Director, Office of Disease Prevention and Health Promotion
In Officio Salutis