PODCAST: The Power of Prevention with Dr. Steven Schroeder
Episode 15 of the TSET Better Health Podcast features its first national guest and public health powerhouse, Dr. Steven A. Schroeder, to discuss the importance of prevention and why it should be a priority in Oklahoma and the United States.
Dr. Schroeder is a physician and Distinguished Professor of Health and Health Care at the University of California San Francisco. He earned his bachelor’s degree from Stanford, his medical doctorate from Harvard, and numerous awards for his work in the areas of public health and prevention. He was the president of the Robert Wood Johnson Foundation for more than 12 years and currently spearheads the Smoking Cessation Leadership Center.
Schroeder’s Shattuck Lecture, “We Can Do Better – Improving the Health of the American People,” published in the New England Journal of Medicine, focuses on the public health risks of smoking and obesity and how they have been managed in the U.S. His findings suggest that despite high health care spending and standards, the U.S. ranks poorly in health rankings compared to other top economic nations. While trauma care and disease treatment are critical components of health and medicine, disease prevention saves money, health and lives.
“The United States has by far the most sophisticated health care system in the world, and yet when you measure our public health outcomes – how long people live, if they die prematurely, infant mortality – we don’t do very well,” Schroeder said. “The reasons don’t have so much to do with lack of medical care, but it has to do with things like deaths from smoking, from alcohol, from automobile accidents, from not getting immunized.”
He shares an allegory of a Good Samaritan rescuing drowning swimmers from a stream. Eventually, he says, someone suggests going upstream to find the source of the crisis, and they discover that the bridge has collapsed.
“We need to do more upstream medical care in addition to downstream,” Schroeder said.
The key to improving quality of life in the United States is prevention, according to Schroeder. Up to 40% of deaths from five leading causes are preventable through behavior change, such as improving diet, rejecting tobacco and getting enough physical activity.
Prevention can be categorized as primary and secondary. Primary prevention includes efforts to prevent the harmful behavior from occurring in the first place, such as Tobacco 21 laws. Secondary prevention mitigates accumulating risks and disincentivizes harmful behavior, such as Clean Indoor Air laws or raising cigarette prices.
“People are what’s called ‘price sensitive,’” Schroeder said. “So if it costs more to buy a pack of cigarettes, you may stop altogether or you may just smoke fewer cigarettes.”
While smoking rates have improved over the decades due to rigorous public health campaigns, smoking-related deaths are still “way too high,” according to Schroeder, and obesity rates have increased dramatically.
“We are having now an epidemic of obesity in all western countries,” Schroeder said. “In part that’s because we eat a lot of calories and in part it’s because we’ve become more sedentary. That’s gotten worse during the COVID epidemic because we’ve been shut in. There’s a lot of criticism about the type of food that we eat and a lot of focus on sugar-sweetened beverage. Some policies in some parts of the country have said we should try to do with Coca-Cola and Pepsi what we’ve done with tobacco, which is raise taxes as a disincentive.”
Food deserts and predatory fast food marketing are a prevalent problem. Schroeder says social class and ethnicity often play a role in the American obesity epidemic.
“In certain areas, it’s easier to get sort of pre-prepared snack food, cokes, candy bars, fried foods, and harder to get fresh foods and vegetables,” he said. “So the good news is that smoking rates are going down, so we can be optimistic about that, and give a lot of credit to public health for putting a priority on policies that try to reduce smoking. Obesity – we’re still feeling our way. We don’t have a good formula for that yet, but we’re wrestling with it.”
Prioritizing prevention in public health would save countless lives and spare unnecessary suffering. But prevention can be overlooked because it takes much longer to track results. Trauma care sees immediate gains on a small scale, while prevention care generates large-scale results on a much longer timeline.
“As Walter Cronkite once said, it’s not news when a cat doesn’t get stuck up in a tree,” Schroeder said. “We don’t have any smallpox today. We don’t have any polio. That’s not news. We take it for granted, but that occurred because of prevention.
“My own feeling is a society should be judged by how it takes care of those most in need,” he said, “and so that’s a very good reason to promote prevention to try to improve the health of the public.”