By Mike Gabbard

All too often we think the most promising healthcare solutions will be found in the next generation of exciting technologies.

We look to the future with an eye toward curing some dreadful disease, rather than a focus on prevention. In thinking this way, we gamble on discoveries that have yet to be found and, in doing so, we overlook simple solutions that have withstood the test of time, and which can make a significant impact today, not tomorrow.

As you know, what and how much we eat profoundly affects our growth, development and aging, and the ability to enjoy life to its fullest.

Researchers continue to reinforce the connection between good nutrition and good health. Unfortunately, these researchers are also confirming the connection between poor nutrition and poor health, and even death.

According to a 1996 report published by USDA's Economic Research Service, of the 10 leading causes of death in the United States, four are related to improper diet: coronary heart disease, cancer, stroke and diabetes. These diseases account for over half of the deaths in the United States each year.

Possibly 20 percent of them could be prevented by proper diets. I want to call attention to what I think is one of the most important and often overlooked walking time bombs of our day. It's the skyrocketing cost of diet-related illness to our economy and the challenge to turn it around.

I learned that the Agricultural Research Service of the USDA estimated the economic impact of preventable, diet-related illnesses was between $200 billion and $250 billion per year, depending on the report you read.

But when I looked into the agency's various program breakdowns, I discovered that their numbers didn't add up, so I started poking around on my own.

As a result, I was shocked to discover that just five diet-related chronic diseases cost the U.S. economy a staggering $730.6 billion each year. That's not millions. That's BILLIONS.

This is an estimate of direct medical costs and the indirect impact of productivity losses due to illness and premature death.

In 1994, 85 percent of the older population had one or more of the chronic conditions that have been documented to benefit from nutrition interventions. Probably not much has changed since then.

When you think about what this means for Hawai'i, one can only be saddened. If Hawai'i's health status remains favorable with regard to the prediction that life expectancy will continue to increase, then the elderly population will continue to grow.

This will increase the prevalence of chronic diseases over the next two decades. Many of us and our loved ones and friends will suffer needlessly and/or die prematurely simply because we didn't know or care about how important it is to eat healthy. The prospects of having to pay out this outrageous amount of money just because we didn't eat right only makes matters worse.

The way that unhealthy lifestyles contribute to poor health is a big problem. Changes in lifestyle can improve virtually all areas of health.

Notable areas are those in which Hawai'i's health status is worse than that of the U.S. as a whole or where trends are worsening: infant deaths, hypertension, chlamydia, gonorrhea, tuberculosis, adult and youth alcohol consumption, drug abuse, obesity and seat belt use.

And, although the average citizen might not think so, unhealthy lifestyles often result in the most serious health problems we face, including heart disease, cancer and diabetes.

A great deal of rising healthcare costs are totally preventable because they relate to improper lifestyles, especially poor diets.

So let's review the numbers for five diet-related chronic diseases. It is almost unbelievable that they cost the U.S. economy a staggering $730.6 billion each year.

We'll start with the granddaddy of them all:

• Cardiovascular: $368.4 billion.

According to the American Heart Association and the National Heart, Lung and Blood Institute, the cost of cardiovascular diseases and stroke in 2004 is estimated to be $368.4 billion.

This figure includes both direct medical costs and indirect costs associated with productivity losses due to illness or premature death.

• Obesity: $117 billion.

Despite our efforts to deal with increasingly sedentary lifestyles, Americans are, for the most part, getting fatter. Today, about one-third of all adults in this country are overweight or obese, which places them at increased risk for heart disease, stroke, high blood pressure and some forms of cancer.

The medical costs of obesity are comparable to the economic costs of cigarette smoking.

• Osteoarthritis and osteoporosis: $50 billion.

According to the USDA, dietary modification is a sensible, practical and economically feasible approach to the prevention of osteoporosis and arthritis.

• Cancer: $189.5 billion.

As you know, many studies have correlated human consumption of diets rich in fruits and vegetables to a lower risk for specific chronic diseases such as cancer and cardiovascular conditions. In 2002, The American Cancer Society re-affirmed its findings that one-third of the 500,000 annual cancer deaths in the United States are due to poor diet and lack of exercise, which leads to excess weight and obesity, while another third is from cigarette smoking.

• Diabetes: $132 billion.

Almost 6 percent of the population has diabetes, with much higher levels in certain age groups and ethnic populations. It has been shown that more than 90 percent of normal U.S. diets contain less than the minimum suggested dietary intake for chromium. Many studies have shown that improved chromium nutrition leads to improvements in risk factors associated with diabetes in the majority of the subjects.

The direct medical costs of diabetes more than doubled in that time, from $44 billion in 1997 to $91.8 billion in 2002.

Focus on prevention

In short, diet-related illnesses cost the nation $730.6 billion.

The figure is actually higher, but I adjusted it to $730.6 billion to account for the fact that the American Cancer Society says only one third of cancer is related to diet.

Note that I did not include the third of the costs that the Cancer Society attributes to smoking, which would be an additional $63 billion.

In each of the other disease categories there are other contributing factors as well, but I am told that virtually all the drivers relate to lifestyle and diet.

Now, I have to point out that this $730 billion tab is just for five chronic diseases. That's frightening enough. The true total for all diet-related illnesses would be nothing less than terrifying.

With this shocking number in mind, the single most significant issue in public health policy is the disconnect between what is covered and what is needed. Rather than focus on prevention — and keep people from getting sick — our approach to healthcare is based on curing people after they get sick.

This is not just in Hawai'i; it's the same throughout the rest of America today.

Think about it. What's being done to focus on prevention? Very little. Health insurance typically pays for medical services to cure illness, but virtually nothing for prevention, outreach and disease management. Meanwhile, government prevention initiatives fall far short of the need.

Since many, if not the majority, of illnesses are preventable and related to poor lifestyle choices, more focus needs to be placed on prevention.

What should we be doing? In terms of illnesses that relate to lifestyles or diet, you know the standard options. We need a major, stepped-up public education initiative to:

1) help stop smoking, drug abuse and alcoholism.

2) provide early prenatal care, with the goal of helping more young mothers to bring their babies to full term.

3) encourage people to adopt healthy lifestyles by eating well-balanced diets.

Hawai'i has a great example in a doctor who has focused on prevention. Dr. Terry Shintani treated hundreds of Native Hawaiians suffering from obesity and attendant problems such as diabetes and severe joint pain.

And, of course, we need to exercise regularly. At the very least, we must bring back PE to our schools.

We also need to mainstream "alternative" healthcare practices as an essential option to help prevent illness. As it now stands, the healthcare practitioners who are in the "up front" part of the profession (as opposed to those who treat people after they get sick) aren't even respected as members of the healthcare profession.

We also need to increase access to affordable healthcare. Three ideas for consideration include:

• Expanding health plan options by which clients can tailor plans to meet their particular needs.

• Expanding healthcare infrastructure at the local level to increase access to medical and dental care.

• Using more mid-level health practitioners, such as nurse practitioners and physician assistants, to provide healthcare in preventive medicine clinics.

And, finally, all of our zoning and building codes should require developers to include options for physical exercise in their designs for new construction.

Getting 'in your face'

Having said all this, I keep getting back to that $730 billion figure and wonder why we couldn't just focus on making a major dent in it just by getting people to eat healthier.

I know it's a deceptively simple challenge. But I submit that to do anything less is irresponsible.

Our typical diet in Hawai'i today contains too much total fat, saturated fat and calories, but not enough of other important elements such as calcium. To make my point, just think about all the Spam entrées in our local fast-food and short-order restaurants.

We know from research that low fruit and vegetable consumption and high saturated fat intake are associated with coronary heart disease, some cancers and diabetes. So why don't we do something about it that really makes a difference? I suspect it's because, for whatever reason, we have been unable to gain consensus on what to do about it.

Is that a good excuse?

I think not.

The Healthy People 2010 project recommends that we eat at least three servings of vegetables and two servings of fruit per day. Unfortunately, less than 25 percent of the U.S. population consumes at least five servings of fruits or vegetables a day.

To remedy this situation, the CDC is collaborating with the National Cancer Institute, the American Cancer Society and three Department of Agriculture agencies to expand federal support for the national 5 A Day for Better Health program.

I think that's great, but it's too little, and too far removed from Hawai'i, to be of any real use here. Sure, we'll tap it and there will be some noise, but it will fade away. Of course, our own state government and local healthcare organizations are doing what they can, but it's not enough.

We need to put in place an education program that is so visible and so "in your face" that it will succeed in effecting social change.

I think we can do this by establishing major, local, community-based programs that use multiple approaches to provide people with the knowledge, skills and attitudes necessary to eat a healthful diet and be physically active.

These programs should work with local organizations to identify target populations, and they should solicit full community participation in a comprehensive approach that addresses the physical, social, political and cultural environments affecting community members.

I have to admit, I got this idea from a program recommendation in one of the CDC health projects. I think it's just what we need here in Hawai'i. For it to succeed, however, this initiative will require the full force of the government and private sectors, with the private healthcare sector participating in a true, pre-competitive spirit.

To do any less would be irresponsible.