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Picture this: people drowning in a rushing river as they get carried downstream. Onlookers try to save as many as possible, but some perish. After some time, one courageous bystander decides to see why people are drowning in the first place. This smart person sees a bridge over the river with a big hole in it, which people are falling through. He repairs the hole, and people stop falling through and drowning.

Right now, our health system has more than a few holes in it, and many people are falling through the cracks. With health care reform (or is it health-insurance reform now?) on the tip of everyone's tongue, we're all riled up about taxes, coverage and deficits. But in this mess, we're forgetting to look upstream and fix some of the preventable health concerns that cause such a strain on the system in the first place.

When politicians refer to prevention and health care, they're usually talking about preventive intervention in a clinical setting - routine checkups, colonoscopies, mammograms, etc. Those things are important, but if a patient is being screened for diseases, he is likely already at risk for developing them. Furthermore, a 2006 study published in the American Journal of Preventive Medicine showed that few preventive services actually save money. It's like trying to catch people midair: You're trying to stop them from hitting the water, but they're already falling.

Some risk factors, like age or genetic predisposition, are unavoidable. But not all of them are. Heart disease, diabetes and other chronic illnesses often result from unhealthy eating and physical inactivity and are preventable drains on our physical and fiscal health. Yet only 5 percent of our health care dollars are spent on prevention.

Keeping people healthy to begin with depends on the communities we live in. But it's naive to ignore the impact the everyday environment has on choices. If vending machines are stocked with sugary beverages and fatty snacks or the closest playground is 10 blocks away, making healthy choices becomes difficult. In all the discussion around a public option, insurance regulation and prescription price, the importance of things we typically take for granted, like accessible grocery stores and safe parks and sidewalks, is often overlooked.

In Philadelphia, many communities lack supermarkets. Just last month Fresh Grocer opened a location in Northwest Philadelphia - the first supermarket in over 40 years in that neighborhood. In communities without supermarkets, families are forced to depend on corner stores for food purchases. Elementary-school students report that they visit corner stores daily, spending up to $2 per visit on foods high in fat and sugar: chips, candy, soda, french fries. How can we expect people to stay healthy if buying produce means spending extra money and time on transportation, and an even tighter food budget?

One great program that addresses this concern is the Agatston Urban Nutrition Initiative. AUNI, a major component of the University's Netter Center for Community Partnerships, improves community health through increased access to healthy food and nutrition education in Philadelphia public schools.

"In terms of access [to healthy food], built environment has a huge impact," says assistant director of education Toby Martinez. "We are creatures of habit, and if buying produce means going out of our way, or if it's more expensive, we won't do it."

The West Philadelphia Recess Initiative, another program co-sponsored by the Netter Center, focuses on the physical-activity component of community health. WPRI bolsters understaffed recess supervision to prevent bullying and injuries, promote physical activity and engage children in games and activities. When kids are able to enjoy recess rather than worry about bullying or being excluded from large, unorganized games, they're more physically active.

Right now, our health care system is almost entirely focused on what happens after people get sick. In order for health reform to succeed, we need a paradigm shift. And it's not as radical as it sounds. Just like seat-belt and helmet laws reduce injury and anti-smoking legislation decreased smoking rates, a prevention-oriented approach to health care can really help shrink the holes in our current "sick-care" system.

Katherine Rea is a College junior from Saratoga, Calif. Her e-mail address is

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