Thanksgiving Resolution: Invest in Health, not Health Care

Published on November 22, 2016

This Thanksgiving Week, as we ponder things to be thankful for, I am starting to build my wish list of resolutions for the New Year.

Here is the first, in the form of an excellent piece from Christianna Silva at FiveThirtyEight: “Why don’t food and housing count as health care?”

The United States spends twice as much as it should on HEALTH CARE, and not nearly enough on HEALTH. Combined, the total dollars are there; we have the budget – we must reallocate the dollars. Instead of waiting until people are sick and treating the symptoms, we have to reach upstream to understand the root causes of illness, and treat the source.Health Care vs. Health Infographic from The Washington Post

The Robert Wood Johnson Foundation reviewed academic studies to identify what causes the risks that translate into health outcomes. What causes illness?

Hint: NOT clinical care.

At best, only 10-20% of outcomes are driven by clinical care (access to care, quality of care). The balance are other factors – social, behavioral, environmental, and economic. Yet as a nation we spend less than 9% of our expenditures towards disease prevention – almost everything goes to treatment.

Even cancer.

Worldwide, the American Institute of Cancer Research concludes: “Cancer costs $895 billion annually. Comparatively, heart disease costs $753 billion. Nothing else comes close, with traffic accidents and diabetes each costing about $204 billion.”

According to the Journal of American Medical Association (Oncology), four lifestyle behaviors can eliminate much of cancer risk. “A substantial cancer burden may be prevented through lifestyle modification. Primary prevention should remain a priority for cancer control”:

  • Do not smoke
  • Limit drinking (at most 1 drink per day for women, 2 per day for men)
  • Keep a healthy weight (BMI 18.5-27.5)
  • Exercise 30 minutes, 5x per week

We can slash our cancer expense by focusing on healthy behaviors, instead of selling expensive treatments and medicines – why don’t we?

Cincinnati Children’s Hospital gets it – instead of simply treating an increase in childhood asthma cases, they moved upstream to identify the root causes: environmental factors like water, mold, and pests were the drivers. Housing code violations alone accounted for 22% of the variation in asthma related ED visits and hospitalizations.

Engaging with the broader community to deal with housing code violations and housing instability improves health at the source, and reduces the need for ever more expensive ED visits and asthma inhalers.

My wish for the New Year?

Increase our focus on addressing the complex social, behavioral, environmental, and economic needs that create a health burden. We can solve our health care spending crisis by shifting resources to fund upstream health interventions.

We cannot afford to wait.

If you’re interested in more articles on this topic, check out:

“To Lower The Cost Of Health Care, Invest In Social Services” – A blog post from Health Affairs

“Looking at social determinants of health in the U.S. and comparable countries” – A blog post from Peterson-Kaiser Health System Tracker

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