Heart disease, stroke, and diabetes account for 36.6% of deaths in the U.S., which can be significantly reduced by changing just three risk factors -- decreasing smoking, increasing exercise, and improving healthy eating. Despite the high rates of preventable death in the United States, investment in prevention has been historically modest, accounting for only 4% of all health care expenditures. The good news is that community-based prevention programs work. An increasing body of evidence demonstrates that well-designed interventions can change behavior and reduce both the incidence and severity of disease. In July 2008, Trust for America's Health published Prevention for a Healthier America, which demonstrated that modest investments in community-based preventions ($10 per person) could result in dramatic health care savings ($16.5 billion in five years). As part of that study, The New York Academy of Medicine conducted extensive literature reviews to identify high-quality studies evaluating the effectiveness of community-based prevention. Focusing only on community-based interventions designed to reduce tobacco use, increase physical activity, and/or improve eating habits, we located and reviewed 84 articles for inclusion in the return on investment model. The attached report summarizes a sample of these articles as well as some additional studies addressing other behaviors and preventable conditions (e.g., asthma, falls prevention, and sexually transmitted infections) that were not included in the original report.
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