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Clinical Preventive Services
Clinical preventive services, such as routine disease screening and scheduled immunizations, are key to reducing death and disability and improving the Nation’s health. These services both prevent and detect illnesses and diseases—from flu to cancer—in their earlier, more treatable stages, significantly reducing the risk of illness, disability, early death, and medical care costs. Yet, despite the fact that these services are covered by Medicare, Medicaid, and many private insurance plans under the Affordable Care Act, millions of children, adolescents, and adults go without clinical preventive services that could protect them from developing a number of serious diseases or help them treat certain health conditions before they worsen.
For example, regular colorectal cancer screening beginning at age 50 is the most effective way to reduce a person’s risk of getting the disease.1 Despite the potentially life-saving effectiveness of this screening test, only 25% of adults age 50 to 64 in the United States, and fewer than 40% of adults age 65 and older in the United States are up to date on colorectal cancer screening and other recommended clinical preventive services.2 Increasing the number of people who take advantage of and have access to clinical preventive services continues to be a major public health challenge.
The Clinical Preventive Services Leading Health Indicators are:
Health Impact of Clinical Preventive Services
Clinical preventive services offer tremendous opportunity to save years of life and to help people live better during those years. Moreover, science-based prevention can save money—and provide high-quality care—by helping people avoid unnecessary tests and procedures. Evidence-based preventive services are effective in reducing death, disability, and disease, including:
Certain cancers, such as colorectal cancer, breast cancer, and cervical cancer
Chronic diseases, such as heart disease and diabetes
Infectious diseases, such as influenza, chicken pox, and pneumonia
Mental health conditions and substance abuse
Vision disorders
For example:
Clinical preventive services to prevent cardiovascular disease alone could save tens of thousands of lives each year.3
On average, 42,000 deaths per year are prevented among children who receive recommended childhood vaccines.3
Blood pressure screening and control is one of the most effective ways to prevent heart disease and stroke. Among people with diabetes, blood pressure control reduces the risk of cardiovascular disease by 33 to 50%.3
Water fluoridation reduces tooth decay by 25% in children and adults.3
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Clinical Preventive Services Across the Life Stages
The U.S. Preventive Services Task Force releases recommendations for preventive services based on rigorous review of the evidence. These recommendations, in combination with the Centers for Disease Control and Prevention’s (CDC’s) recommended immunization schedules and the Bright Futures guidelines for children and adolescents, provide a comprehensive set of recommendations for primary and secondary preventive services for all Americans—from infancy through old age.
Children and Adolescents
Immunizations can protect children and adolescents from serious and potentially fatal diseases, including mumps, tetanus, and chicken pox.
Early screening can detect vision and hearing problems in young children.
Screening children and adolescents for overweight and obesity can protect them from adverse health outcomes later in life.
Adults
Regular checkups that measure weight, blood pressure, and cholesterol levels can protect men and women from chronic diseases, such as heart disease and diabetes.
A Pap test every 3 to 5 years for women aged 21 to 65, depending on age and testing method can protect women from cervical cancer.
A mammogram every 2 years beginning at age 50 can detect early signs of breast cancer in women.
Colorectal cancer screening beginning at age 50 can protect both men and women from colorectal cancer.
“Booster” immunizations can protect both adult men and women against tetanus, diphtheria, and whooping cough.
Determinants of Clinical Preventive Services
Many of the strongest predictors of health and well-being fall outside of the medical care setting. Social, economic, and physical environmental factors all influence health. For example, educational attainment, stable employment, safe homes and neighborhoods, and access to appropriate clinical preventive services tend to affect health positively.
Access to clinical preventive services in various medical care and community settings must also address logistic factors, such as adequate transportation and time off for workers, to help them get the care they need. Addressing these determinants is key in reducing health disparities and improving the health of all Americans.
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Disparities in Clinical Preventive Services
Significant health disparities in access to clinical preventive services exist and are closely linked with social, economic, and environmental factors. For example:
In 2008, a greater proportion of people who are white non-Hispanic received recommended colorectal cancer screenings (57.2%) than any other racial or ethnic group. In fact, the proportion of people from other racial or ethnic groups who had not received colorectal cancer screening is 15% to 56% higher than the white non-Hispanic population.
In 2008, the proportion of people with advanced educational degrees who received recommended colorectal cancer screenings was almost twice as high (70.4%, age adjusted) as for people with less than a high school education (36.8%, age adjusted).
In 2005 to 2008, people age 65 and older with diabetes had the lowest rate of uncontrolled hyper- and/or hypoglycemia (5.0%), compared to adults age 45 to 64 (14.4%) and 18 to 44 (26.8%).
In 2009, the rate of incomplete childhood vaccination is 18% higher among children without medical insurance than for children with private medical insurance.
In 2005 to 2008, females (52.0%, age adjusted) had a higher (better) rate of hypertension control than males (38.6%, age adjusted).
In 2005 to 2008, the rate of uncontrolled blood pressure among adults with hypertension was 27% and 10% higher among people who are Mexican American and black non-Hispanic, respectively, than people who are white non-Hispanic.
A lesser proportion of people who live in rural areas receive recommended preventive services (e.g., cancer screening and management of cardiovascular disease) in part because of lack of access to physicians and medical care delivery sites.4
About the Disparities Data
All disparities described are statistically significant at the 0.05 level of significance.
Colorectal Cancer Screening (C-16)
Blood Pressure Control (HDS-12)
Uncontrolled Glycemia in Persons With Diabetes (D-5.1)
Data are from the NHANES, CDC, NCHS.
Complete Vaccination Among Children (IID-8)
Data for this measure are available annually and come from the National Immunization Survey, CDC, National Center for Immunization and Respiratory Diseases, and NCHS.
Complete vaccination is defined as receipt of the following doses of each of the following vaccines: 4 DTap, 3 polio, 1 MMR, 3 or 4 Hib (depending on product type received, including primary series plus the booster dose), 3 Hep B, 1 varicella, and 4 PCV.
Public and private insurance are not mutually exclusive. About 5% of children with medical insurance are included in both categories. "Other" types of insurance (e.g., military insurance, Indian Health Services coverage) are not included.
References
1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention. Frequently Asked Questions About Colorectal Cancer . Atlanta, GA: 2011. Available from http://www.cdc.gov/cancer/colorectal/basic_info/faq.htm#6
2 Healthy Aging Program, Centers for Disease Control and Prevention. Clinical Preventive Services . Atlanta, GA: 2011. Available from http://www.cdc.gov/aging/services/index.htm
3 National Prevention Council, Office of the Surgeon General, U.S. Department of Health and Human Services. National Prevention Strategy . Washington, DC: 2011. Available from http://www.healthcare.gov/prevention/nphpphc/strategy/report.pdf [PDF - 4.67MB]
4 National Prevention Council, Office of the Surgeon General, U.S. Department of Health and Human Services. National Prevention Strategy . Washington, DC: 2011. p.25. Available from http://www.healthcare.gov/prevention/nphpphc/strategy/report.pdf [PDF - 4.67MB]
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