Health Promotion and Disease Prevention

Health promotion and disease prevention for older adults are two very different enterprises in contemporary America. Health promotion takes place primarily on one's own or is conducted in the community under the guidance of a wide variety of practitioners who may or may not be licensed or certified. Disease prevention takes place primarily in medical clinics, is increasingly covered by Medicare, and is conducted by licensed medical personnel.

The effectiveness of health-promoting activities for older adults has been consistently supported by research studies, although lingering questions remain. Can the benefits achieved in short-term research projects be sustained over the long term? Can health promotion interventions be initiated successfully by busy clinicians in medical settings? Do the benefits of insurance coverage for health promotion interventions outweigh the costs of implementing them?

In contrast, similar questions are not asked about disease prevention and detection for older adults (in the form of medical screenings and immunizations). Over the past 15 years, coverage by Medicare has expanded rapidly for these services. In addition to pneumococcal and influenza immunizations, medical screenings now covered under Medicare include tests [Page 266]or exams for the following conditions: cardiovascular disease, diabetes, breast cancer, osteoporosis, cervical cancer, colorectal cancer, and prostate cancer.

The expansion of Medicare services to include medical screenings over the past decade has been a boon to the health of older Americans. But more than research results have contributed to this expansion. Some 7,000 lobbyists in Washington, D.C., promote medical priorities exclusively, and in 2000 two organizations alone—the American Medical Association and the American Hospital Association—spent $28.5 million lobbying Congress.

There are few lobbyists and not much money, however, spent to persuade Congress to include health promotion in Medicare or other insurance coverage. Consequently, health-promoting activities are infrequently covered by insurance, are not linked to medical care, and are practiced by only a minority of older adults. For instance, approximately one in four older adults gets adequate exercise or practices good nutritional habits consistently.

This entry briefly summarizes three health-promoting strategies for older adults and four prevention interventions.