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Daily monitoring helps patients keep control

There are currently about 100 patients districtwide.

The monitors send the information via a telephone connection, making it necessary for the patient to have a touchtone phone. Patients are screened by the VA for their eligibility in the program.

For more information about the program, call Chaffin at (800) 827-8244 ext. 3262.
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Dr. WOOLF. Thank you, Senator Kohl, Senator Smith, other members of the Committee.

My name is Steven Woolf. I am a family physician and a specialist in preventive medicine and public health. I serve as professor of Family Medicine, Epidemiology and Community Health at Virginia Commonwealth University.

I am pleased to talk with you this morning about prevention and seniors.

The prevention of disease is the cornerstone of healthy aging. The underlying logic is obvious. The major diseases that claim the lives of seniors and account for the rising cost of health care are caused largely by our health habits, such as smoking, lack of exercise, and poor diet. These behaviors account for one out of three deaths in the United States.

We spend great sums on treating the complications of disease, and far too little on helping the public avoid getting sick in the first place. As Arkansas Governor Mike Huckabee has said, rather than building a fence at the top of a cliff, our health care system keeps sending ambulances to the bottom. Paying for prevention is a smarter use of scarce resources.

Many seniors wrongly believe they are too old to benefit from a change in health habits, but the facts are that seniors live longer and live healthier if they abandon unhealthy behaviors, obtain recommended vaccines and receive certain screening tests that catch diseases early. Prevention can improve function and postpone disabilities, as we have just heard.

Healthy again ought to begin early in life when it is more effective, but reducing risks for disease pays off at any age.

Prevention has always been important, but is taking on greater urgency now when more Americans are growing older and the costs of health care loom large.

At a time when we worry about how Medicare will afford these costs, it is a mistake to ignore the business case for prevention.

In the face of these benefits, it is concerning that so many older adults in our country engage in health habits that increase their risk. In an average group of 100 Americans who are age 65 and older, 25 of the 100 are obese; 25 get no exercise; and 10 smoke cigarettes.

Altogether, five million seniors in this country smoke cigarettes. Obesity rates are climbing, and the averages I am quoting for America's seniors obscure higher rates of risk factors among subgroups, such as African Americans, Hispanics, and Native Americans.

Millions of seniors have not received recommended vaccines. For example, one out of three have not received the pneumococcal vaccine, which helps prevent deaths from pneumonia. Congress has worked for many years now to expand coverage for preventive services under Medicare, thereby, removing a major barrier to access. The Medicare Modernization Act in 2003 introduced the Welcome to Medicare visit and expanded coverage for cardiovascular and diabetes screening. Yet, we see that Medicare coverage by itself does not make it happen.

The GAO found that only 10 percent of beneficiaries had received five cancer tests and immunizations that are covered under Medicare.

The problem is worse among beneficiaries who are poor or among minorities. For example, whereas the proportion of Medicare beneficiaries who have received a recent flu shot is 67 percent for Whites, it is 53 percent for Hispanics, and 43 percent for African Americans. This is among Medicare beneficiaries.

This Committee already knows that life expectancy is lower among minorities, but the scope of the problem is less well known.

People aged 65 to 74 are almost 50 percent more likely to die in the next year if they are African American than if they are white.

We spend billions of dollars in this country to make better drugs and medical devices, thinking this will save lives, and indeed it does. But far more lives could be saved by correcting health disparities. For every life saved by medical advances, five would be saved if African Americans had the same death rate as Whites.

Congress has enacted legislation to address disparities, but that investment is actually a small fraction of the billions we spend on research. Most of those billions are in the pursuit of medical advances, a worthy aim, but if correcting disparities saves more lives than medical advances, do we have our proportions right?

Certainly, we must continue to invest heavily in new drugs and technology, but perhaps we should tip the scales a bit and make more substantive investment in removing barriers to receiving those treatments.

Enabling all Americans to enjoy aging is not only ethical, it will save more lives and will go further to control the costs of medical


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With that background, let me devote my remaining minutes to some policy options for promoting prevention among seniors.

I offer seven examples, but I urge the Committee to gather broader input from other experts, assemble a longer list of policy options, and choose from the best.

We owe it to America's seniors to pursue the most innovative and effective strategies to promote healthy aging. My written testimony elaborates on the following seven suggestions.

No. 1, Congress should use its visibility with the public and the media to launch a public education campaign aimed at America's seniors to emphasize prevention. Getting the message out that prevention is important to the health of seniors is the first step toward changing public attitudes and creating a new culture for healthy aging.

No. 2, Congress should encourage the Centers for Medicare and Medicaid Services, CMS, to become more proactive in encouraging Medicare beneficiaries to adopt healthy lifestyles. My written testimony explains that existing CMS initiatives concentrate on making beneficiaries aware of expanded coverage benefits, but they tread lightly on giving health advice. Congress should encourage CMS to adopt a new role in which health advice is disseminated by CMS to serve beneficiaries, to lower disease burden, and to save money through prevention. CMS need not develop this health advice from scratch. Prevention guidelines for seniors and health education messages have already been developed by other HHS agencies, but are less familiar to CMS due to stovepiping.

No. 3, looking ahead to the future, the Committee should consider how to redesign communities to support lifestyle change. It does little good to advise a senior to do light gardening or take a daily walk when he or she is surrounded by highways or has no safe place to walk.

Seniors living in poor urban neighborhoods are often miles from a supermarket that offers healthy food choices. Fast food chains predominate, as do billboards that promote cigarettes and alcohol.

Congress should work with the food industry and retailers to explore ways to promote profits and healthy customers.

Ultimately, creating a community that fosters healthy aging requires a partnership across community sectors involving churches, restaurants, park authorities, senior centers, and urban planners.

No. 4, cigarette smoking remains the leading cause of death and cannot be overlooked in any serious discussion of healthy aging. The Committee should look again at the 10 recommendations issued in 2003 by the Department of Health and Human Services' Interagency Committee on Smoking and Health. Setting aside the recommendation on excise taxes, which received a cool reception, the plan includes nine other excellent recommendations that would substantially reduce the death toll from smoking-related illness among seniors.

One example is telephone quit line programs, which give seniors access to high quality assistance in quitting smoking.

No. 5, the failure of so many seniors to receive recommended preventive services is a symptom of a larger problem with the nation's health care delivery system. Experts have warned for years that the quality of health care in America is in jeopardy unless bold system redesigns are undertaken. Mapping the human genome, robotic surgery, and other sensational breakthroughs make the evening news, but Congress could save more lives by directing its attention elsewhere.

Take reminder systems, for example, which alert people when screening tests or vaccinations are due. Such systems are not glamorous, but are among the most effective ways to close the gaps in the delivery of health care. Yet, they are rare in our health care system. You are more likely to get a notice from your car dealership that it is time to change your oil than you are to be notified by your doctor that your mammogram is overdue.

Our research team has shown that making such systems routine would save far more lives than the advances in drug therapies on which billions of dollars are now spent.

I urge Congress to confront the political challenges and to press for modernizing the health care system to deliver consistent highquality care.

No. 6, information technology is an important tool for healthy aging. Congress is already promoting electronic health records to improve record keeping and reduce medical errors, but information

technology and web sites for seniors can do far more by empowering consumers with information to make healthy lifestyle choices, learn more about the tests they need, and obtain e-mail reminders when they are due.

Congress should steer the health IT movement beyond its basic role, serving providers as a tool for patient care, to a broader role in helping the public maintain good health.

Finally, No. 7, given the urgency of the problems I have discussed, Congress should increase the funding for AHRQ, the Agency for Healthcare Research and Quality, which receives one penny for every dollar given to NIH. Yet, it is AHRQ that has lead responsibility for all that we have discussed-prevention guidelines, improving the quality of health care, tracking racial disparities, developing information technology, and so on.

Solving these problems is not a luxury on the margins of NIH. Without the answers, the cutting edge advances made at NIH cannot reach Americans.

Doubling the budget of AHRQ sounds extravagant at this time of belt tightening. But the extra penny taken from the NIH dollar could go much farther in saving lives. The threat to the nation's health and economy posed by the struggling health care system makes it risky public policy to not invest generously in tackling these problems. Thank you.

[The prepared statement of Dr. Woolf follows:)

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