Dr. Dariush Mozaffarian
speaker
96 appearances
3 recordings
2 series
first heard Jan 2025
last heard 25 May
Dr. Dariush Mozaffarian’s voice in public audio — every appearance, attributed to the second.
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recordings per month · last 12 monthsRecordings per month over the last 12 months — 2 in all, peaking in May 2026 with 2.
Appearances
It's exactly what we need to be doing to look for win-wins that are both economically good for everybody and also good for health and well-being.
It's exactly what we need to be doing to look for win-wins that are both economically good for everybody and also good for health and well-being.
We have a $3.6 trillion healthcare system and frankly, you can't make as much money on prevention as you can on treatment.
We all agree that prevention's important, but why has it not been that policymakers sort of elevated, why haven't they elevated this issue to the top? And I came up with a couple of reasons that I'd be happy to share. I think the first is, and you touched on this, a lot of policymakers are just reactive in general, and prevention requires a proactive approach.
And the reason they're reactive is whether you're in the executive branch or you're a member of Congress, there are oftentimes so many emergencies, either real or imagined, or crises, or political controversies, that oftentimes you spend a lot of time reacting. Putting out the fire. Absolutely. As opposed to thinking about proactive policies to improve health.
And then prevention oftentimes takes time as well. So you have to have that patience. And oftentimes the results are, at least from a public health perspective, are often invisible when things are working and health is being protected. And so I think the first reason is that the mindset of policymakers needs to shift from being reactive to proactive.
The second reason is it could very well be that policymakers are just not as attuned to the evidence base, whether it's lifestyle medicine, whether it's prevention, whether it's a social determinants of health. Understanding the evidence now that has been generated about the effects of all of these other modalities, I think is critical.
And when you don't know the evidence, then you tend to think, well, that might be a slush fund. Those dollars in prevention might be a slush fund and why should we support it? There are others then, as you said, who may think of prevention as, you're right, part of the nanny state. Prevention is about individual responsibility and the government shouldn't be involved.
So I think those are a couple of reasons, but then I think it goes beyond that. Prevention and public health, they require resources. And right now in this country, if you look at our national health expenditure accounts, only about 3% of our dollars go to public health. Only about 5% go to primary and secondary prevention.
And so even though we're in a tight fiscal climate, we're always going to be in a tight fiscal climate. Finding opportunities through our discretionary budgets or mandatory budgets, CBO doesn't always help with their tenure. budget window in terms of scoring.
Absolutely. Absolutely. And I think that's a very important point. And I think, so there needs to be more focus on finding the will really, the political will to expand resources using our discretionary budgets, as well as our mandatory budgets and through Medicare and Medicaid, because that's really how we scale things. So I think that's also a critical point.
I think Dr. Hyman, another reason why policymakers haven't gravitated towards prevention is we have a $3.6 trillion healthcare system. And frankly, you can't make as much money on prevention as you can on treatment. So the incentives there in the system are not as much there. Now, value-based healthcare- Not from the government, but from the people running healthcare. Absolutely.
Now, value-based healthcare transformation with the focus on payment based on outcomes as opposed to volume should change that over time. But that's- It's gonna be a long haul.
Absolutely, absolutely. We're about a decade into this, but still the vast majority of healthcare payments are still currently paid based on the services provided and a fee per service. So we're not quite there. And I think the last reason why this hasn't really gotten the attention of policymakers is really, I think if you look at the general public as well, we haven't galvanized
the American public, and whether that's they don't realize the power of prevention or we haven't communicated to them the importance of sound policies to support the healthy choice. Policymakers need to
help americans make the healthy choice the easy choice and so i think galvanizing the public you know they're not a lot of lobbying firms or interest groups going to members every single day in the halls of congress preaching preaching the power of prevention but but you do need a grassroots movement you do need the american public to say hey
I'm doing everything I can every day for my family to eat well, to exercise, to avoid substances, to stop smoking, to drink alcohol in moderation. I'm doing everything I can. But if there are not community supports, if there are not policy supports, if there aren't policy systems and environmental change helping me and my family, it's going to be very, very difficult to do.
And I think that's a critical message in this book.
Prevention, public health, it's too important to underfund this. And there needs to be bipartisan support to finance evidence-based prevention and public health interventions. So it could be community-based prevention programs. I talk about several things that we did at Health and Human Services from the Recovery Act back in 2009.
There are opportunities to finance the public health infrastructure, which is significantly underfunded in this country. The public health emergency fund, so the next Ebola or the Zika we face, we're not waiting on Congress to fight for months at a time before their resources, but targeted investments to lift up prevention and public health, that has to be a national priority.
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