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DoD Looks to Prevention as Cure for Costly Care

By Douglas J. Gillert
American Forces Press Service

WASHINGTON, Oct. 21, 1998 – If you saw your child playing on a busy street, you probably would tell him it isn't safe to play there. Then, you'd take him by the hand and lead him to safety.

"As I look at some of our life styles, the net effect is the same," said Dr. (Lt. Gen.) Charles Roadman, Air Force Surgeon General. "We know people are virtually playing in the traffic by the things they elect to do." What's needed, he said, is a health-conscious community that adopts healthy life styles geared toward preventing disease and illness.

Roadman recently accepted the challenge to change the life styles and practices of military health care beneficiaries. As the DoD executive agent for preventive health, he leads a DoD-wide effort that focuses on three areas: smoking cessation and the reductions of alcohol abuse and accidental injuries. Lowering these health risks will save lives in the near term and money in the long term, he said.

In 1996, DoD spent $1.3 billion on direct and indirect costs for cigarette-related illnesses and $1.6 billion on alcohol-related illnesses. "Out of that came about $1 billion in direct health care costs," Roadman said. "That's out of a $15 billion budget."

Roadman is keenly interested in human costs. He recalled his grandfather, who died of lung cancer in his early 60s. "If he had quit smoking, how long would he have lived, and would he have seen his grandchildren?" the general wonders.

"When you talk about prevention and wellness, that's not a current money saver," he said. "Down the road, it may be a budget issue, but right now it's a human cost issue. What DoD needs is a health standard that says we want everybody to have as long and high quality a life as possible."

Each of the service departments is championing a segment of the prevention plan. The Air Force oversees tobacco issues, while the Navy works alcohol issues and the Army tackles preventable injuries. However, multiservice, multiagency teams guide each segment. "We're pulling this together as a tri-service approach," Roadman said. "No one service branch can accomplish this alone."

In June, interservice teams of specialists from medical, safety, personnel and other disciplines began scrubbing a draft plan that "vigorously and aggressively" tackles the three preventive health issues, said Lt. Col. Wayne Talcott, chief of substance abuse prevention for the Air Force. The plan targets the total DoD population -- active duty, Guard and Reserve, civilian employees and all health care beneficiaries.

The smoking cessation segment reflects how each portion of the plan will work, Talcott said. This part calls for reducing smoking rates 5 percent per year and cutting smokeless tobacco usage in half to 15 percent by 2001. The plan calls for education and prevention programs; targeted interventions; decreased accessibility and availability of tobacco products on military installations; and research.

"The focus of the new DoD effort is to achieve and maintain a constantly fit and ready force and [to establish] health communities here and overseas," Roadman said. "Successful preventive health requires everyone's involvement -- from commanders, to physicians to patients. It is a community issue. We need to understand what it is we need to do to take care of each other."

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