Читать книгу The Science of Health Disparities Research - Группа авторов - Страница 76

Acknowledging that the continual increase in the cost of healthcare is unsustainable—the share of the US economy devoted to healthcare in 2015 was 17.8%, an increase of 5.8% over 2014—and that prevention is more cost‐effective than treatment, the Massachusetts Public Health Association helped create a $60 million trust fund for community‐level health strategies from those who would benefit from the savings—health plans and large healthcare systems [28]. Its aims included increasing healthy behaviors, reducing health disparities, reducing rates of the state's most costly preventable health conditions, developing a more robust evidence base of effective prevention programs, and promoting implementation of workplace programs that promote wellness. Public health advocates made public health part of the debate of a healthcare cost‐containment legislative initiative and built a robust coalition of businesses, civic leaders, and local government officials.

This multilevel approach has served more than 372 000 Massachusetts citizens, and evaluators estimate cost savings in targeting diet and nutrition, leisure‐time exercise, and stress reduction to be between $760 000 and $4.1 million [29]. Over a lifetime, hypertension programs are expected to avert healthcare costs $9 million to $16 million, while tobacco use programs could save from $622 118 to $5.6 million. Other advances are expected in building capacity, improving affordable housing environments, and engaging hard‐to‐reach populations.

Another promising initiative, especially in reaching the Latino community, has been the use of promotores de salud (community health workers/promoters). These bilingual, bicultural health advocates work directly in communities, often being directly employed from the neighborhoods that they serve, and link communities to healthcare providers, healthcare services, education, and resources [15]. In Latino communities, promotores have helped to reduce stigmas associated with certain medical conditions and have increased use of mental health services through community advocacy and healthcare navigation [15].