When it literally costs an arm and a leg...

We spend so much money fire-fighting acute issues that there is little money or political will available for prevention programmes. I’ve been thinking about this in the light of my own experiences and those recently reported by Jamie Wallace and his Walkit project. The issues are common to the people in the projects that I mentioned yesterday.

The economics of prevention versus cure has been starkly highlighted in an excellent series of articles about the New York experience of diabetes in the New York Times (it’s a registration/subscription site so there is little point in providing the links). 1 in 8 adult New Yorkers now has Type 2 diabetes, with the incidence rising to 1 in 5 in some neighbourhoods and for some demographics (like the over-65s). Diabetes exacts a vicious psychological and physical toll on many people and has an extraordinary impact on their quality of life. An estimated 800,00 New Yorkers have diabetes, yet the New York Public Health Authority has a staff of 3 and a budget of 950,000 dollars to address the spread of the disease.

With such different models of health-care funding, it’s remarkable that health-care in the UK has many of the funding issues that Health Maintenance Organizations have in the US but for different reasons. 7 years ago, in New York, hospitals opened 4 innovative diabetes centres that were meant to function as boot camps for diabetics. The centres taught diabetics to monitor their blood sugar, watch their food intake and exercise while under-going intensive monitoring from a multi-disciplinary team. The centres were successful in their education programmes. The Beth Israel Center was so effective that five months into their project, more than 60 per cent of the tested patients had their blood sugar under control. And almost half of the tracked patients had lost weight.