Prevention has not played a big part in health reform discussions to date. Polling suggests that the public is generally supportive of prevention, but concerned about affordability. In addition, there is confusion and vagueness in the public's understanding of prevention concepts, in part due to historically modest investments in preventive efforts. Finally, public support suffers because investments in prevention have been siloed across a fragmented funding and delivery system. Proponents argue that prevention should be a key part of health reform discussions because of its potential to control the growth and costs of chronic illnesses, especially obesity. The key policy challenge is to replicate and scale interventions whose effectiveness have been demonstrated. An increased focus on prevention may also be effective in reducing health disparities. In order to do so, community-based efforts that address environmental and social determinants of health must complement an emphasis on clinical preventable services. One health plan's approach to community-based prevention, Kaiser Permanente's Healthy Eating Active Living (HEAL) initiative, provides an important opportunity to learn which interventions work, and to support replication. The Vermont Blueprint for Health represents one state's approach to testing interventions that integrate provider and community interventions to improve the care and prevention of chronic disease.
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