Will health care reform help keep people healthy?

The U.S. Senate begins debating its version of health reform next week. One issue sure to get attention is curbing the nation's soaring health care costs. Public health experts argue that one of the best ways to lower America's health care bills is to keep is people from getting sick in the first place.

In recent state-by-state rankings of the healthiest people, Minnesota dropped from third in the nation to sixth.

Public health experts such as Minneapolis cardiologist Courtney Jordan say that fall is due to a number of factors including smoking, poor nutrition and a lack of exercise.

Jordan points out that Minnesota's rate of obesity is now 24 percent, and in the nation as a whole, 30 percent of residents are obese.

"No matter what area you practice, you see how obesity affects disease -- everything from high blood pressure, cholesterol to cancer, respiratory illnesses and what not," Jordan said.

Jordan is a consultant in Bloomington, Minneapolis and Hennepin County for Minnesota's Statewide Health Improvement Program, or SHIP. SHIP was part of the state Legislature's 2007 effort to lower health care costs by helping Minnesotans lead healthier lives.

Jordan says one of the problems SHIP is designed to address is that physicians are often focused soley on fixing a patient's current problem, and there's little evidence that they also talk about staving off illnesses.

"The physician needs to say, 'You know what, I've noticed you've gained five pounds since your last visit. You're not exercising, you're not eating as well. I think you should work on changing these behaviors, and I am going to refer you to different community resources for this,'" said Jordan.

Researchers say as obesity rates have gone up, its related illnesses account for about one-third of all health care spending. Smoking also causes serious illnesses such as cancer, emphysema and heart disease.

But the nation spends only a fraction of health care dollars on keeping people well, by doing things like helping them quit smoking and lose weight.

Even in Minnesota in 2003, Gov. Pawlenty and lawmakers drained the state's $1 billion tobacco endowment to balance the budget. The endowment funded programs to help people quit smoking and to prevent kids from starting the habit.

John Finnegan, dean of the University of Minnesota's School of Public Health, says out of every dollar spent on health care in the U.S., only 3 cents is spent on prevention.

"If you want better health, we better spend some time talking about prevention, rather than waiting until they get sick and then trying to save them."

"If you want better health in this country, higher quality, better outcomes, then we better spend some time talking about prevention," said Finnegan, "talking about preventing people from getting obese or having heart disease or cancer, rather than waiting until they get sick and then trying to save them from going over the waterfall."

Both the House and Senate reform bills call for developing a national strategy to improve people's health, both at the federal level and through local, community-based programs. Both bills would set up councils to track which programs work and disseminate those findings nationally.

The Senate bill would create a trust fund for public health programs beginning next year. It would also require Medicaid to cover stop-smoking programs for pregnant women.

The House bill would provide grants to small employers for up to 50 percent of the costs of wellness programs. It would also provide grants for programs to prevent obesity among children and their families, beginning in 2011.

Ken Thorpe, who heads Emory University's Department of Health Policy and Management, gives the reform bills a "B."

"There is certainly recognition that rising rates of obesity and chronic disease are two key issues that are what we have to contend with, if we're going to get a handle on health care costs," said Thorpe. "The challenge is, are the proposals in the legislation aggressive enough and do they kick in fast enough?"

Although national health reforms could be years away from implementation, Minnesota's statewide health improvement program, SHIP, is already underway.

In August, the state Health Department awarded $47 million in grants to communities across the state to help decrease the number of Minnesotans who smoke or who are overweight.

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