Improving quality while reducing cost is the intractable problem of health-care reform. Extending insurance to the currently uninsured might increase costs, while attempting to reduce wasteful medical spending might decrease quality. While every proposal has its trade-offs, one idea is best suited to decreasing health-care costs without impacting quality: disease prevention.

Prevention is not a new concept, and earlier generations have used it to improve public health at little-to-no cost. During the early 20th century, nutritional-deficiency diseases, such as rickets and goiter, were common. These diseases were nearly eliminated following the implementation of food fortification programs. Similar results occurred as better water purification and improved sanitation methods helped reduce the prevalence of cholera and dysentery. All of these programs eradicated serious health problems using preventative measures.

These benefits are not limited to diseases, according to the Journal of American Medical Association. From 1925 to 1997, the annual death rate from vehicle travel declined by 90 percent. This reduction is largely attributable to various preventative measures such as seatbelts, changes in driving behavior, and better highway design.

The Agency for Healthcare Research and Quality released a report on the top 10 most expensive health conditions in 2005. Heart disease topped the list, costing the nation $76 billion in medical expenses, according to a report by the U.S. Department of Health & Human Services. These costs can be reduced through the implementation of certain preventative measures. The Centers for Disease Control and Prevention estimates that $5.6 billion could be saved if 10 percent of adults walked on a regular basis.

One of the important aspects of these successful preventative measures is that they are public-health initiatives rather than improvements in medical care. This distinction is important because it is unclear if preventative medical care can reduce costs. A 2008 study published in the New England Journal of Medicine investigated the cost-effectiveness of preventative medical care. They found that preventative care showed little-to-no cost savings over conventional disease treatment. Of the numerous preventative care measures available, only immunization has consistently demonstrated cost savings.

This is why some of the proposals currently going through Congress are troubling. While they generally do contain provisions to increase disease prevention, they do so through preventative-care options that may not reduce health-care costs. Approaching prevention as a public-health initiative has been shown to be a better approach than increasing medical care.

While it is likely that some type of preventative measures will become law by the end of the year, true reform will only come when serious effort is given to preventing disease altogether. Not only will these measures reduce health-care costs, but they will improve the quality of life for millions of Americans at risk from heart disease, diabetes and other preventable conditions.

Reach columnist Mike Noon at opinion@dailyuw.com.