Published on November 21, 2019
by Kurt Waltenbaugh
Here’s our Carrot Healthy “why”:
We believe in a future with no barriers to better health, a future without 25-year mortality gaps between communities within the same city, a world that invests in creating and maintaining healthy lives – before people get sick.
We believe that shining the bright light of data onto our disparities as a nation will help us, all working together, change the face of health and reverse the approximately 50-year decline driven by increasing barriers to healthy lives.
We at Carrot Health are enabling that future.
It starts by asking, what do we get for our healthcare dollars?
Looking back over the past 50 years, inflation-adjusted healthcare spending per person has climbed from $500 (1970) to nearly $10,000 today. An increase of 20x (or 2000% growth). During that time, life expectancy has grown from 71 to 79. As medicine improved, years living with chronic disabilities grew significantly.
The United States is an outlier. During that same period, from nearly identical starting points, almost every other developed nation spent less and had better outcomes – both mortality and morbidity – by a wide margin.
Why do we get so little for our money?
Here’s the main problem: we wait until people are sick and then spend healthcare dollars to patch them up. Compared to other nations with better outcomes, we spend a trivial amount of money of social and behavioral supports to help people live healthy lives in the first place.
I often ask leaders in the healthcare community to imagine all of the dollars we currently spend on healthcare – insurance, hospitals, physicians, pharmaceuticals, medical devices and equipment… everything! Then take those dollars and give them to a county health board. Give the board instructions to spend those dollars to benefit the population in the county, with the caveat that it is then responsible for the health costs of that population for the next 40 years (not the 12 months that we use today to measure risk).
It’s a good bet the dollars will be spent in a very different way than we do now.
Think about childhood obesity. The true costs of childhood obesity take many years (decades, often) to show up in the healthcare system. Helping those children with diet and lifestyle habits early on can prevent those costs, yet no health insurance company, employer, or hospital system has the long-term incentives required to make an investment today that sees the majority of the savings accrue 10-20 years in the future.
Consumers often receive negative incentives to make healthy changes.
The biggest things we personally can do to better our own health revolve around six behaviors:
- Eliminate/avoid smoking or tobacco products.
- Eat a reasonably healthy diet.
- Exercise 150 minutes each week.
- Maintain a healthy level of body fat.
- Moderate alcohol consumption (zero to max 1 drink/day).
- Maintain social connections to avoid isolation and loneliness.
If we achieve four or more of these behaviors, we cut our risk of most cancers by 60%, and the risk of chronic disease by 80% or more. This accounts for well more than half of the national healthcare spend – $2 trillion each year.
Unfortunately, as individuals, we receive countless messages every day suggesting poor choices in all these categories: diet, alcohol, tobacco, and sedentary devices leading to poor fitness and isolation. Media advertising to consumers is expected to top $240 billion in 2019. We know that marketing works to influence behavior, and individual consumers are hard pressed to fight back against this spend on their own.
In addition, there’s an unequal starting line.
The communities where we are born and live have a large impact on health. There is a 20-year gap between the counties with the longest and shortest life expectancies. That gap persists even at the local level. Communities like New Orleans have a 25-year life expectancy gap for babies born today only 2-3 miles apart!
These gaps are related not to the quality of healthcare but to the disparity in barriers that individuals face to leading their healthiest lives, including income, education, violence in the home/community, access to food, housing stability, and more. Investments in reducing these differences could eliminate more than half of all healthcare spend.
Together, we can fix this.
Help us remove the barriers people have to achieving their healthiest lives.
Help us create a future without 25-year mortality gaps between communities within the same city.
Help us invest a world that puts its resources toward creating and maintaining healthy lives – before people get sick.
Help us enable this future!