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1 | A Success Story In American Health Care: Community-based Prevention in Nebraska | Healthreform.GOV Prevention and Public Health Care in the United States Investing in and improving preventive health care is an integral part of health reform. Preventive health care improves the overall health of all Americans and helps decrease avoidable costs. The U.S. spends over $2 trillion on medical care every year, spending more per patient than any other health system in the world.1,2 The epidemic and growing levels of largely preventable diseases and conditions contribute greatly to these high costs. In fact, one study estimates that almost 80 percent of all health spending in the United States can be attributed to chronic illness, much of which is preventable.3 Heart disease and stroke, for instance, are the first- and third- leading causes of death for both men and women in the United States and account for over one-third of all American deaths.4 In 2008, the total cost of heart disease and stroke for the United States was estimated to be more than $448 billion.5 Cardiovascular disease can be prevented before it progresses, through health screening and interventions for risk factors such as obesity, high blood pressure, high blood cholesterol, diabetes, and tobacco use – yet one in four adults do not receive the cholesterol screening they need, and in 2005, only 67 percent of smokers and 60 percent of individuals with obesity were counseled to quit or exercise, respectively.6 Heart disease and stroke are the first- and The responsibility for disease prevention is a shared one – third-leading causes of death for both men and individuals and families; school systems; employers; the medical women in the United States and account for over ONE-THIRDof all American deaths. and public health workforce; and federal, state, and local governments all have a stake. Community-based prevention efforts, which bring together all of these different stakeholders to Source 4 positively impact the health and well-being of our populations, provide a model for integrative programs to reduce preventable diseases and decrease costs. A Community-Based Prevention Success Story The WISEWOMAN program in Nebraska is an example of how community-based screening and healthy lifestyle interventions can dramatically improve the health of Americans.7