Introduction: A Wake-Up Call
In late January, the Institute of Medicine’scommittee of medical experts under the auspices of NIH issued a comprehensive report on the health of Americans. Based upon data from 13 developed countries in Europe plus Japan, Australia and Canada, the report concluded that other high-income countries outrank the United States on most measures of health. The basic finding? The U.S. is among the wealthiest nations in the world, but it is far from the healthiest.
This report should be read by every hospital CEO and public official in this country. It should be studied by everyone interested in quality of life. I believe it demonstrates a need to rethink the nature of health. This is important because how we view health has consequences for the way we organize health systems – and much more.
Just think for a moment about this one-sentence summary from the NIH expert panel: People living in the United States die sooner, get sicker and sustain more injuries than those in all other high-income countries.
The Sorry Details
In no fewer than 9 out of 11 categories, health status is worse in America than the other 16 leading industrialized nations. In the other two categories, we’re doing better: We’re only next to worst.
Anyone who considers Americans healthy might be shocked to discover that the Institute of Medicine/NIH report indicates just the opposite. The fact is we are in the bottom rank among our peer nations. We are last in life expectancy; we have the highest rates of obesity, infant mortality, low birth weights, heart disease, diabetes, chronic lung disease, homicide rates, teen pregnancy and sexually transmitted diseases.
The chairman of the study panel, Dr. Steven Woolf, a professor of medicine at Virginia Commonwealth University, said:
We were stunned by the propensity of findings all on the negative side – the scope of the disadvantage covers all ages, from babies to seniors, both sexes, all classes of society. If we fail to act, life spans will continue to shorten and children will face greater rates of illness than those in other nations.
If all this does not seem akin to a mass die off of proverbial canaries in a coal mine, then consider this statement in the report:
Advantaged Americans – those who are white, insured, college-educated, upper income – are in worse health than similar individuals in other countries. Even Americans who do not smoke or are not overweight have higher rates of disease than similar groups in peer countries.
It’s Not About Hospitals, Doctors or the Health Care System
Dr. Woolf correctly writes in the report that these key measurements are not directly related to the quality of health care:
On the contrary, health outcomes are determined by much more than health care. Much of our health disadvantage comes from factors outside of the clinical system and outside of what doctors and hospitals can do.
The NIH report offers no sweeping answers or simple solutions. Our poor health status ranking is due mostly to lifestyle-related dynamics, such as dreadful diet and exercise levels. The report devotes a lot of attention to our unprecedented obesity rates, our dependency on a physical environment built around the automobile rather than the pedestrian, the fact that tens of millions are without access to proper medical services, many adverse economic/environmental and social conditions and dysfunctional values and misguided public policies.
The bottom line, as expressed by one panel member, is that we are not preventing damaging health behaviors.
Just so. The report was designed to alert the American public about the extent of the nation’s health disadvantage and to stimulate a national discussion about its implications. Therefore, we might ask what role might health system leaders play to address these kinds of problems, while continuing to offer high quality medical care?
More specifically, can leading hospital systems and business leaders, public officials and concerned citizens do more to educate Americans to live more wisely? Can these leaders be more effective at promoting health (not just delivering quality medical care) so as to increase citizen chances of staying healthy while becoming truly well and remaining that way much longer than most manage to do at present?
Promoting health, in my view, warrants as much priority as delivering high-tech, costly care for chronic medical conditions. The situation is dire. How dire? One expert (well, me) has suggested it might be time for a Marshall Plan-level commitment to REAL wellness to get Americans back on track to become healthier as well as properly medicalized.
What to Do? Look on the Bright Side and Shift Gears
In recent years, the British Medical Journal (BMJ) has devoted entire editions to forums about the need for and paths to an expanded, more functional definition of health. The latter always focuses on building thecapacity of the individual to pursue a full life – and to do it proactively.
Step one usually entails is a reassessment and reawakening of the public to the stark reality that there is no chance that anyone can realize, at least not for very long, the old WHO definition of health as a state of complete physical, mental and social well-being. It sounds good but it’s impossible. We have pains and aches, little disabilities, colds and all manner of hopefully minor ailments nearly all the time. Human flesh is heir to countless troubles.
Step two must involve a needed shift from treating symptoms and consequences of mediocre lifestyles to better ways to organize healthier societies.
Step three is getting it right, understanding the situation. It’s easy to misread the situation. In a Wall Street Journal essay,Sally Pipes, president of a health systems research institute, gets it all wrong. She writes:
Sustaining a superior level of medical innovation will do far more to improve Americans’ health than adopting the health-care policies from overseas.
(See Sally C. Pipes, Those Misleading World Health Rankings, Wall Street Journal – Opinion, February 4, 2013.)
Wrong! No it won’t! Medical innovation is always welcome and it can save lives, cut costs and bring other beneficial outcomes within the sickness care system. But medical innovation will not make people healthier or boost the quality of their lives. People must do that for themselves. The way to do so is at hand – its called living well.
One philosophy for living well is called REAL wellness.