Health and Well-Being Matter is the monthly blog of the Director of the Office of Disease Prevention and Health Promotion.
New treatments and scientific breakthroughs that lead to cures characterize modern medicine. But as exciting and beneficial as many of these innovations are, none compares to the power of prevention. In addition to getting enough physical activity, ensuring healthy eating, and maintaining mental health, a fourth essential — and often overlooked — element in any comprehensive wellness strategy is keeping up with clinical preventive services.
Preventive services can both help prevent illness (primary prevention) and identify health problems early (secondary prevention), when clinical interventions are most beneficial. Preventive services include screenings, tests, checkups, patient counseling, and vaccines to help define risks for, prevent, or recognize diseases and other potential health problems. Different preventive services are important at different stages of the lifespan, but they all involve increased awareness of one’s personal needs and/or seeing a health care provider at somewhat regular intervals.
While this concept is simple enough, putting it into practice is often challenging. The proportion of adults who received appropriate evidence-based, clinical preventive services was very low prior to the pandemic (6.9 percent of adults in 2018). And while it remains to be seen exactly how COVID-19 has impacted — and may continue to impact — uptake in these services, the pandemic has undeniably exacerbated the problem. One study found that primary care visits (used as a proxy measure for access to preventive services) decreased by 21 percent in the second quarter of 2020 (compared with the second quarters of 2018 and 2019)— and without ever returning to pre-pandemic levels.
This decrease in preventive service utilization is an issue for children as well as adults. According to a recent study, in 2020 more than 26 percent of households reported that at least one child or teen had missed or delayed a preventive visit due to the pandemic. Public-sector vaccine-ordering data from the Centers for Disease Control and Prevention (CDC) showed a 14 percent decline in 2020–2021 compared to 2019. In addition, measles vaccination rates declined by more than 20 percent, and vaccination rates for kindergarten children during the 2020–2021 school year decreased by about 1 percent from the previous year.
So, how do health care providers and public health professionals raise awareness about the importance of keeping up with preventive services and encourage people to access such services? What’s more, how do individuals track their own personal preventive health needs — or those of loved ones — and translate that understanding into action?
It starts with recognizing risks and the need for preventive strategies to mitigate risk. For providers, this demands an appreciation of the wide range of risks experienced by people from a wide range of circumstances — including their individual biology, home environment, social context, work conditions, health literacy, and economic stability. The interplay of an individual’s physical and mental condition with their unique social determinants of health will help inform which preventive strategies are appropriate.
If you’re a health professional who wants to access the latest recommendations for preventive services, acquainting yourself with the U.S. Preventive Services Task Force (USPSTF) website is a good first step. The USPSTF is an independent, volunteer panel of national experts in primary care, disease prevention, and evidence-based medicine working to improve health nationwide through recommendations for clinical preventive services.
Resources from the Agency for Healthcare Research and Quality (AHRQ) also provide invaluable insight into the delivery of preventive care. The AHRQ website features a number of programs and tools, a variety of research and data, and other materials to support health care organizations.
Further, both health care providers seeking a health information tool for their patients and individuals wondering which preventive services they need can take advantage of ODPHP’s MyHealthfinder. The MyHealthfinder tool is a wellness resource that consumers can use to learn about clinical preventive services recommended for them. Largely based on USPSTF recommendations, the site includes health information in English and Spanish that’s actionable and easy to use. MyHealthfinder offers original content and helpful resources, including:
- An assessment tool that provides personalized recommendations for clinical preventive services
- Over 100 prevention and wellness topics
- Tools like conversation starters and questions for the doctor
Organizations can also use our application programming interfaces (APIs) to seamlessly add MyHealthfinder content to their websites to help share evidence-based health information with the people who need it most.
ODPHP also recently launched the Take Good Care campaign to encourage Black and Hispanic women ages 45 to 54 to make preventive care a priority by using MyHealthfinder. The Take Good Care campaign leverages the MyHealthfinder assessment tool to support specific audiences’:
- Awareness of their recommended clinical preventive services
- Intent to get clinical preventive services they may need
And last — but not least — are resources to support uptake of preventive services. The Patient Protection and Affordable Care Act (the Affordable Care Act or the ACA) requires most health plans to cover the full cost of a set of preventive services when delivered by a provider in the plan’s network. This includes plans available through the Health Insurance Marketplace®. People enrolled in Medicare have access to similar benefits.
Medicaid, though administered by states, is covered by Title IV of the ACA. It identifies multiple ways the federal government works with states and agencies to expand access to preventive services. While not universal in coverage, these programs offer a variety of resources to support — in whole or in part — the preventive service needs of those who qualify for Medicaid coverage. For more information or specifics related to your state, please visit Medicaid.gov.
Providers, public health professionals, local and regional health care organizations, community service providers, free clinics, and public health event organizers can use these resources to help those they serve learn about and access critical preventive services.
Most importantly, we must continue to recognize that prevention is ideally defined in terms of the unique circumstances of each individual. We must measure prevention in terms of individual risks and balanced with a particular person’s needs. And we must always consider the extraordinary disparities in access to preventive services when addressing an individual’s approach to preventive health care.
If you or someone you love has missed health care appointments during the pandemic or put off preventive services for any reason, now’s the time to pick up the phone and follow up. Making preventive care happen may mean putting in some extra thought and effort, taking another few minutes out of the day, or even reaching a little deeper for a creative solution — but it will be worth it.
That ounce of prevention may just save a life.
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