Tobacco Documents Online

OPENING STATEMENT SENATOR WILLIAM S. COHEN "AN OUNCE OF PREVENTION SAVES A POUND OF CURE" MAY 6, 1993 Mr. Chairman, thank you for calling this hearing to highlight the importance of health promotion and prevention programs for older Americans. One of the biggest problems with our current health care system is that it focuses so many resources on treatment and so few on prevention. We spend billions of dollars on elaborate high-tech equipment and medical services once serious illness or injury occurs. Yet we scrimp on the low-tech, preventive services and programs that could have helped us avoid such situations all together. Health care reform presents us with a real opportunity to shift our emphasis from "curing" to "preventing." We should, for instance, make certain that preventive services are covered under any standard benefit package, as I have proposed in my own health care reform bill, the Access to Affordable Health Care Act. And I was pleased to hear from Mrs. Clinton this morning that the Administration is also emphasizing prevention in its proposal. All Americans must be encouraged to adopt more responsibility for their own health and physical well-being. The best health care system in the world will not protect a smoker from the ravages of lung cancer and emphysema. It will not lower the blood pressure of the person who is unwilling to exercise or adjust his or her diet. And it will not protect the person who abuses alcohol from cirrhosis of the liver. As noted author and physician Dr. Michael Crichton has observed, "the future of medicine lies not in treating illness, but in preventing it." Many of our most serious health problems are directly related to unhealthy behavior -- smoking, poor diet, lack of exercise, and abuse of alcohol and drugs. Today, more than ever, the way we die is directly related to the way we live, and an ever-expanding body of evidence shows that investments in health promotion and prevention offer returns not only in reduced health care bills, but in longer life, increased productivity, and an improved quality of life. Typically health promotion and disease prevention programs have been targeted to young or middle-aged persons, and I share the Chairman's concern that older Americans not be overlooked in our efforts to promote good health and prevent disease and disability. All too often, growing old is automatically and erroneously associated with growing frail. Many older adults are never advised to stop smoking or encouraged to start exercising, even

though studies have demonstrated that such interventions can prove extremely beneficial. For instance, despite mounting health evidence showing it's never too late to quit, many smoking cessation programs do not target older people. Recent studies have found that older men and women benefit just as much -- and perhaps more -- from quitting as their middle-aged counterparts. When older people quit smoking -- even after decades -- the benefits to their hearts and circulatory systems begin immediately and their risk of heart attack and stroke decreases dramatically. Senator Pryor will be releasing an Office of Technology Assessment report today that estimates the total financial cost of smoking to be $68 billion a year -- that's $1,078 for every smoker. Tobacco-related diseases cause more than 434,000 deaths annually in the United States, and more people die each year from smoking than from AIDS, suicide, alcohol, drug abuse, homicide, car accidents and fires combined. Over 2,000 of my Maine constituents die each year from smoking-related illnesses and over $125 million is spent in the State on direct health care costs related to smoking. It is therefore becoming increasingly clear that true health care reform, with its necessary emphasis on preventive health, must deal with the issue of tobacco use. As the Institute of Medicine observed in its 1990 report, The Second 50 Years, our policies and attitudes toward the elderly must shift from the "pessimistic" to the "realistic." Older people do not have to accept decline as an inevitable consequence of age, and it is never too late to begin activities or interventions that will improve both quality of life and functional independence. As with younger people, perhaps the greatest challenge is to encourage those most in need -- the sedentary smoker, the socially-isolated or depressed individual -- to participate. MR. CHAIRMAN, targeting additional health promotion and prevention efforts to older Americans will yield major dividends -- fewer functional disabilities; improved physical, mental, and social well-being; and a postponement of the need for long-term care. Such programs not only reduce health care costs, but also add "life to the years, and not just years to the life," and I look forward to the upcoming testimony.