Professional Point

Given developments in the democratic primaries throughout the winter, the presidential contest for November is essentially set. And, if the recent public-opinion polls are any indication, health care is likely to be a prominent issue in the run to the White House: It places second just behind the economy as an issue foremost in people's minds. Yet, what can or will happen with health-care reform remains an open question. While there is much agreement that the health-care system is broken, there is little consensus as to the appropriate "fixes." As I indicated in my last column, there is perhaps no greater ideological divide in the current Congress than about health-care reform, where one side views privatization and market forces as holding the key, while the other side views increased government involvement as the right tack to take.

Irrespective of which version of health reform unfolds, psychology's direction is clear: We must continue to keep our focus on working to demonstrate the value of psychological services and ensure access to services irrespective of the vicissitudes of the health-care reform process.

Lifestyle influences health

Although the ultimate incarnation of health reform remains unclear, the next incremental step toward reform is coming into focus. More than ever before, lifestyle and behavior are being recognized as important factors in physical health and physical illness. Psychologists have been well aware of this for some time, but only recently have consumers, employers and Congress also begun to appreciate the connections.

Perhaps this large-scale insight about lifestyle and behavior is the result of "discoveries" of late related to obesity and diabetes. Congress, in the Senate report accompanying appropriations directives for this year, underscored that "obesity has become our nation's fastest-rising public health threat with the disease affecting nearly one-third of the adult American population." Studies are beginning to show that obesity is a bigger health threat than smoking and alcohol abuse and it leads to increased risk of chronic diseases such as diabetes, heart disease, stroke and cancer.

The Senate report also points out that the dramatic increase in obesity is particularly associated with a nationwide increase in diabetes. Its review of the literature found that at least 80 percent of patients with type 2 diabetes are overweight or obese. And research is also showing an alarming escalation in the number of children diagnosed with type 2 diabetes. Not to be ignored is the fact that problems with obesity and diabetes also disproportionately affect minority communities. Importantly, the congressional report recognizes that "Many of the chronic diseases linked to obesity are preventable. Recent studies provide strong evidence that prevention efforts focusing on diet, exercise and other lifestyle changes can result in substantially reduced risk among high-risk groups." Without increased prevention efforts, the country is left with total direct and indirect costs attributed to overweight and obesity totaling $100 billion in annual health-care costs, according to Congress.

Psychology can help

The implications for psychology of widespread recognition of the role of lifestyle for illness prevention and risk reduction are profound. Psychologists, who are experts (perhaps the experts) in behavior, have much to offer in this arena. And, unlike previously, resources are actually beginning to flow into prevention and risk-reduction activities. Despite years of talk about the importance of prevention and health promotion, few if any real dollars were being allocated and spent to support these activities. By contrast, Congress has now appropriated close to $950 million dollars for programs designed to increase physical activity, healthy lifestyles and nutrition.

Employers, too, are seeing the "investment" wisdom of using resources to develop health-promotion programs in the workplace. Some are "stand-alone" interventions intended to target obesity. Others are incorporated into disease management services targeted to diabetes and cardiovascular disease, for example.

While this shifting focus for the expenditure of health-care dollars is good news for the country and potentially good news for our profession, not everyone understands the role psychologists can and should play in health promotion and disease management. We need to continue, indeed step up, our efforts to educate policy-makers and decision-makers about the value and benefits of psychological services in these areas. It certainly will help to gain more congressionally mandated projects, such as the one the Practice Directorate recently secured to demonstrate the value of integrating psychological services into the treatment of Medicare patients with cardiac disease (see the article in the March Monitor ). Focusing greater attention on the value of psychological services, such as through this project, is a welcome development along the path to any health-care reform.