Editorial: Toward a Healthier America

Toward a Healthier America The nation took a close look at itself in 1980 and, in many ways, decided it didn't like what it saw. That was most evident when the people said "no" to another four years with Jimmy Carter, elected Ronald Reagan as president and turned the leadership of the Senate over to the Republicans. The changes appear to bring with them an end to many of the health programs urged by the Carter administration and Democratic leaders like Sens. Edward Kennedy and Russell Long-national health insurance, catastrophic health coverage, and mandatory cost controls. It could well halt the Food and Drug Administration's creeping regulatory efforts like that to require patient package inserts (PPIs) for a large number of prescription drugs. "What ails American medicine," the Republican platform of 1980 said, "is government meddling and the straightjacket of federal programs." Early indications from Reagan planners are that many new and recent regulations will be rescinded or suspended and that the new thrust to such problems as cost containment will be stimulated by competition in the marketplace. Certainly, there can be no doubt that the major ill in the health system is cost. National health expenditures doubled from 1950 to 1960, tripled again by 1970, and tripled again by 1980, reaching well over $200 billion last year. Republicans and Democrats alike realize that this type of uncontrolled growth in health spending cannot continue unchecked. At the same time, Americans expect to receive the quality of care American medicine has achieved-and they expect more answers and more cures to their ills. The National Center for Health Statistics has just released its annual report giving Americans a pretty good bill of health. Among the findings in the 463-page tome called Health, United States, 1980: • Most groups of people-from newborns to victims of cardiovascular disease-are living longer, with the life expectancy now at 73.3 years for those born this decade; • Violent deaths have decreased in categories such as homicide and suicide, although deaths from motor vehicle accidents were up some 11 % from 1976; • Hospital stays in the United States are generally shorter than in other countries, decreasing from 8.5 days just a decade ago to 7.5 days now. For the remainder of this decade, the government says, there should be increased attention to prevention and control. Specific target areas should include: better control of high blood pressure; more family planning; control of sexually transmitted diseases; improved infant health and prevention of complications during pregnancy; control of infectious diseases; halting misuse of alcohol, drugs and tobacco; improved nutrition and exercise; and control of stress and violent behavior, including child abuse and neglect. The report stated specific goals for pharmacists: • By 1990, adverse reactions from medical drug use that are sufficiently severe to require hospital admission should be reduced by 25%; • By 1990, pharmacists dispensing prescription medication should routinely counsel patients on the proper use of drugs designated as high priority by the Food and Drug Administration, with particular attention to prescriptions for pediatric and geriatric patients and to the problems of drinking alcoholic beverages while taking prescription drugs; • By 1990, standard, good medical and pharmaceutical practice will include drug profiles on 90% of adults covered under the Medicare program and on 75% of other patients with acute and chronic illnesses being cared for in all private and organized medical settings. And the report called on all health care professionals to help keep consumption of alcohol and drugs below current levels and to help reduce adult smoking to below 25% and teenage smoking to below 6%, by 1990, a significant reduction from current levels. If voluntary approaches to health cost containment are to work in the next decadeespecially in the next four years--pharmacists and other health professionals must take heed and work to reach these overall goals. If Americans believe that "What ails American medicine is government meddling" and mandatory government programs, then the obvious answer is to voluntarily improve the nation's health without adding significantly to its cost. Pharmacists, in particular, can playa vital role in this voluntary effort. We urge that you help make it work. -WES 2

American Pharmacy Vol. NS21. No.2. February 19~