By Elsa Perez Dean, BSN/Dietetic Intern
Lost amidst the chatter and debate surrounding the Affordable Care Act (ACA) is one of the most significant changes it will bring. First and foremost, the Affordable Care Act is not perfect, but it is an important step in healthcare reform and access to usable healthcare insurance. The shift in focus with the Affordable Care Act from treatment to prevention is significant.
As a dietetic intern and future nutrition professional, it has been ingrained in my education that the key to health is through a healthy balanced diet and physical activity. For many, however, the obstacles to obtaining these two basic elements of health are many, making them more susceptible to chronic illnesses such as type 2 diabetes, hypertension and cardiovascular disease; all of which are costly to treat yet preventable with access to preventive health care.
You may ask what this means. In simple terms, a goal of the Affordable Care Act is to emphasize preventive care by requiring that insurance carriers provide basic screenings, wellness visits, and other services, such as nutrition counseling, at no charge. This is intended to encourage people to be screened periodically and work with healthcare professionals to address signs of chronic illness before they become debilitating. This is in contrast to the current paradigm of waiting until the symptoms of chronic illness require emergency services or other medical attention far too late into the progression of the disease.
The ACA includes several provisions that were put in place over the last 3 years to put prevention at the forefront of healthcare. For example, the Prevention and Public Health Fund has provided grants to programs throughout the country aimed at assessing and addressing needs of the community for the purpose of improving health outcomes. In California alone, there are over 48 state run programs that have used these grants for various prevention programs. From conducting data collection of specific neighborhoods, for the purpose of assessing the health issues of that community, to funding outreach and clinic programs aimed at increasing screenings and immunizations.
While the Affordable Care Act shifts the focus from healthcare through treatment to health care through prevention at the individual level, it also forces us to recognize that health is impacted by various risk factors that contribute to chronic disease in the context of the environmental or community level. For example, studies suggest that children who live in food deserts and have limited access to healthy, nutritious foods are at higher risk of developing obesity and obesity-related chronic diseases.Various epidemiological studies also suggest that the risk of obesity is higher in low-income populations due to lack of physical activity which can be attributed to lack of safe play areas for kids. Obesity prevention is just one aspect that connects health to the larger environment.
As a future dietetic professional, my primary concern is to help educate individuals about making healthy lifestyle choices and promote good health. Understanding the role of individual responsibility is one aspect of health but can’t be addressed without also taking all environmental factors into consideration. The prevention of chronic illness is a multi-faceted societal issue that must be addressed from various perspectives. The Affordable Care Act is a significant law and one of many vital components of a multi-faceted approach that puts prevention at the forefront of health equity.