Breastfeeding Promotion in Primary Care

Clinical Preventive Services and Advocacy Letter

1 Clinical Preventive Services

There are a number of reasons why clinical preventive services like lung cancer screening, breastfeeding support, and skin cancer prevention counseling should be covered by health insurance plans. First, these services can save lives. For instance, early detection of lung cancer through screening can dramatically improve survival rates (National Lung Screening Trial Research Team, 2011). Similarly, skin cancer is one of the most preventable types of cancer, and yet it continues to be a leading cause of cancer death in the United States. Second, these services can save money in the long run. Third, these services improve the quality of life for patients: patients who receive breast cancer screenings often report feeling more empowered and in control of their health; patients who catch lung cancer in time are spared a worse fate down the road; and the same goes for skin cancer. In short, these services are important, and should be equitable and accessible to all patients regardless of income or social status. All Americans should have access to these lifesaving preventive measures.

Lung Cancer Screening

It is important to note that, with early detection, patients have a higher survival rate and subsequently require less intensive and expensive treatments. Furthermore, research suggests that for every dollar spent on screening, three dollars are saved in treatment costs (Erb-Downward et al., 2011). When these cost savings are taken into account, lung cancer screening becomes a more cost-effective proposition for insurance companies. In addition to reducing treatment costs, early detection also has the potential to improve population health by reducing mortality rates from lung cancer. Consequently, insurance companies and policy-makers should consider the potential value of lung cancer screening when making decisions about coverage and funding.

The science behind lung cancer screening is well-established. Although there is some debate about the ideal screening strategy, the general consensus is that low-dose computed tomography (CT) scanning can significantly reduce mortality from the disease (National Lung Screening Trial Research Team, 2011). A recent study found that, when compared to no screening, CT screening resulted in a net savings of $333 per person (Erb-Downward et al., 2011). This is due in part to the fact that early detection of lung cancer can lead to less invasive and less expensive treatment options (Pyenson et al., 2012). Thus, both the scientific evidence and the economic data support the use of CT screening for lung cancer. Although there are other important issues to consider when making policy decisions related to health care, these data suggest that insurance companies should be required to cover CT scans for lung cancer screening.

Breastfeeding: Primary Care Interventions

Providing accurate information about the benefits and challenges of breastfeeding, as well as practical advice on how to establish and maintain a good milk supply, can make a significant difference in whether or not mothers are able to successfully breastfeed their infants. In addition, insurance companies may be willing to provide financial incentives to healthcare providers who offer breastfeeding instruction to their patients, as this intervention has the potential to decrease healthcare costs in the long run. For instance, there is evidence indicating that breastfeeding mothers are less likely to suffer from post-partum depression (Borra et al., 2015). By working together, healthcare providers and insurance companies can help to improve population health and reduce healthcare costs.

Suffice to say, breastfeeding is a low-cost, yet highly effective, primary care intervention that is grounded in science. Numerous studies have shown that breastfeeding helps to reduce the risk of certain chronic diseases, including obesity, Type 2 diabetes, and cardiovascular disease (Horta et al., 2015). In addition, breastfeeding has been shown to boost cognitive development and increase IQ scores; moreover, it has been linked to lower rates of Sudden Infant Death Syndrome (SIDS) (Stuebe, 2009). These health benefits are well-documented in the medical literature and provide strong evidence for insurance coverage of breastfeeding services. Insurance coverage would ensure that all women have access to these life-saving services, regardless of their socio-economic status. In addition, it would help to offset the costs associated with breastfeeding, making it more affordable for families. Ultimately, insurance coverage of breastfeeding services is critical for ensuring that all women have the opportunity to breastfeed their babies and enjoy the many benefits that it provides.

Skin Cancer Prevention: Behavioral Counseling

Skin cancer is the most common form of cancer in the United States, with more than three million cases diagnosed each year (Watts et al., 2017). Although the majority of skin cancers are non-melanoma, which are relatively easy to treat, melanoma skin cancers can be more aggressive and difficult to treat. Behavioral counseling has been shown to be an effective intervention for reducing ultraviolet (UV) exposure and, as a result, reducing the incidence of skin cancer. Given the high cost of skin cancer treatment, insurance companies could potentially save billions of dollars each year if more people adopted behaviors that prevented skin cancer. In addition to the economic benefits, behavioral counseling interventions also have the potential to improve population health by reducing the incidence of skin cancer.

Behavioral counseling to prevent skin cancer via sun protection is effective and grounded in a strong evidence base. Studies have shown that interventions delivered via individual, group, or computer-based methods were all effective in increasing sunscreen use and/or decreasing sunburn incidence among adults (Hubbard et al., 2018). There are also clear economic benefits to insurance coverage for behavioral counseling to prevent skin cancer. One cost-effectiveness analysis found that behavioral counseling interventions resulted in netcost savings of $3.8 million over 10 years when compared to no intervention (Watts et al., 2017).

Dimensions of the Policy-Making Process

Policy-makers must balance the need to do what is right with the need to do what is practical. This can be particularly difficult when it comes to public health policy, as there is often a tension between individual rights and the greater good. The issue of skin cancer prevention via behavioral counseling provides a good example of this tension. On one hand, there is a strong case to be made for government intervention, as skin cancer is a major public health concern. On the other hand, many people argue that requiring people to change their behavior infringes on their individual rights. Ultimately, it is up to policy-makers to weigh the evidence and make the best decision they can.

One of the most important considerations in the policy-making process is evidence. When crafting policy, decision-makers must weigh the available evidence to determine what is most likely to be effective. This can be a difficult task, as different studies often produce conflicting results. Another important consideration is ethics: because there are so many different ethical perspectives—from utilitarianism to deontology to ethical egoism, it is difficult to arrive at an ethical consensus.

There are a number of reasons why evidence-based policies are more effective than those that are not. For one, they are based on a solid foundation of research that can be reviewed and evaluated. This allows for a clear understanding of the potential benefits and risks of a given policy. In addition, evidence-based policies are less likely to be based on personal biases or agendas. Instead, they are driven by a desire to improve public health outcomes. Ultimately, policies that are rooted in both ethics and evidence are more likely to be effective in achieving their goals. They offer a well-rounded approach that takes into account both what is known to work and what is morally right. This provides a strong foundation for developing policies that can improve the lives of those they impact.

Thus, whether it is lung cancer screening, breastfeeding or skin cancer interventions, policy has to be based on evidence and the right ethical perspective. Anything less is an invitation to legal trouble, lawsuits, and an upset public. The public has the right to make health decisions on its own, and this must always be respected.

Conclusion

Lung cancer screening, breastfeeding, and behavioral counseling to prevent skin cancer are all evidence-based interventions that can have a positive impact on social change. Lung cancer screening can lead to earlier detection and treatment of lung cancer, which can save lives. Breastfeeding has been shown to improve infant health and reduce the risk of certain chronic diseases. And behavioral counseling to prevent skin cancer can help people learn how to protect themselves from the sun and reduce their risk of developing skin cancer. All of these interventions have the potential to improve public health and make a positive difference in the lives of individuals and communities. The better the health policy, the more likely the public is to be healthy and the greater the positive social change tends to be.

Letter to Legislator

Dear Senator Rand Paul

As a doctor, you know the importance of effective health care policy in helping to prevent the spread of disease.

As your constituent, I am writing to urge you to support coverage of three clinical preventive services for women: lung cancer screening, breastfeeding as a primary care intervention, and skin cancer prevention via behavioral counseling.

Lung cancer is the leading cause of cancer death and has taken the lives of thousands of women in the United States each year. Early detection is critical. Additionally, breastfeeding has been shown to reduce the risk of numerous chronic diseases in both mothers and children, and is an effective intervention for diabetes. Skin cancer is the most common cancer in the United States, and behavioral counseling has been shown to be effective in reducing risk factors for skin cancer.

These services are all important. They can help to improve the health of women throughout the US. And they can prevent a great deal of expensive care down the road.

I hope that you will consider my request and support coverage of these three important clinical preventive services for women. Thank you for your time and consideration.