aAmerica’s healthcare system is bankrupt. And America’s healthcare system must be fundamentally transformed to lead its repair.
Let’s look at the data first. The United States currently spends over $4 trillion annually on healthcare. This equates to nearly 20% of the gross domestic product. But life expectancy in the United States is seven years behind dozens of other countries, including Portugal, Slovenia and Turkey. If this trend continues, life expectancy will drop to 64th in the world by 2040, but per capita spending will continue to grow significantly more than nearly any other country.
Diagnosing this disorder is not difficult. Nearly all the money we spend on healthcare goes towards the cost of medical interventions. However, clinical care is responsible for up to 20% of health conditions. The vast majority of factors that determine an individual’s health are built into his or her surroundings. That is, how many times you have to change buses to get to the store that sells fresh vegetables. Is there light and fresh, clean air coming through the windows at work? How often do they face the stress and pain of being discriminated against because of their skin color?
These are the social drivers of health, but for too long our healthcare system has largely ignored them.
They have ignored them in pursuit of profit. You can make money by claiming for cancer treatment. Not even using institutional leverage to demand sidewalks, parks and streetlights in poor neighborhoods.
Myopia function is also built into the system. A recent analysis of the board members of top-ranked US hospitals found that less than 15% of board members are medical professionals. Nearly 57% came from the financial and business sector, mostly in private equity, wealth management and banking. They are accustomed to looking at spreadsheets rather than wrinkles of anxiety etched into patients’ faces, and their decisions reflect that experience.
Read more: Why so many Americans are dying young
This status quo is no longer acceptable.
Hospitals and health systems have enormous wealth. The largest companies (even those technically listed as nonprofits) have billions of dollars in cash and investments on their balance sheets, with some posting record surpluses during the pandemic. . The health care system is also highly influential, often being the largest employer in the region and a source of large political contributions.
It’s time to use that wealth and influence to address the social factors that promote health. Hospitals and health systems are as aggressive as they attack cancer with advanced drugs and surgeries to treat and ultimately prevent diseases caused by poverty, inequality, racism and loneliness. should be mobilized to
There are several promising models in this study.
Kaiser Permanente has pledged $400 million to a social impact investment fund that will build 30,000 affordable homes by 2030. The fund will also support economic development in low-income communities. In Portland, Oregon, six major health systems are working together to help nearly 400 homes supported by extensive case management services for those without shelter or at risk of losing their homes. built an apartment. Similar projects are being launched in hospitals and health systems in places like Denver and Toronto.
Other hospitals are focusing on improving access to nutritious meals by setting up food pharmacies with fresh produce and offering free cooking classes.
While these are welcome initiatives, they are just the beginning. To transform America’s health, any profitable healthcare system will need to commit real money (we recommend at least 2% of its annual budget) to address a wide range of societal factors. Identifying local needs and promoting local solutions requires building true partnerships with community groups. And we must develop champions for this initiative in our executive leadership and on our boards.
At a time when healthcare worker burnout and exhaustion are so prevalent, it may seem unfair to ask hospitals to take on this task.
However, there is growing evidence that health care worker burnout is not driven by sheer workload, but by disillusionment with the health care system. No wonder. Doctors and nurses go to great lengths to save patients from medical crises, but they send them back to communities lacking nutritious food, safe housing, affordable child care, and mental health counseling. It’s almost certain that we’ll have another medical crisis in the next few weeks. It is discouraging and depressing.
In the short term, we hope that serious efforts by the health system to address the upstream drivers of worsening health conditions will energize health care providers. I am convinced that in the long run it will bring real benefits, not only to individual well-being, but also to improving national welfare. The declining health of Americans is taking a toll on productivity, the economy, and even national security. Addressing the social factors that promote health has tremendous growth potential.
where do i start? One of us previously proposed a ’10 team challenge’ to the healthcare system. Here we add another area of focus to the original framework.
The list below raises obvious questions. Are hospitals in the business of strengthening voting rights or reforming the prison system? Of course, they always do so not as leaders, but as active and generous conveners and participants.
We recognize that we are proposing a fundamental shift in the US medical business model. This is going to be a lot of work. It takes decades. But it has to be done. Anything less than that is a medical malpractice.
All hospitals and health systems should commit resources towards measurable progress in:
- universal health insuranceAccess to regular preventive care is an important first step in promoting good health.
- food security, To ensure that everyone has access to healthy, nutritious food.
- residential securityincluding evidence-based ways to end chronic homelessness.
- Medical and social support for immigrantsThat includes the 10 million illegal immigrants in the United States who often lack access to preventative care.
- A Criminal Justice System Based on Healing and RecoveryIt will go a long way in dealing with mental illness and substance abuse.
- Decarbonization of healthcareThis is because the industry accounts for about 8.5% of global greenhouse gas emissions.
- voting rightsensuring that all adult citizens have a voice in choosing policy makers who listen to the needs of their communities.
- strong schoolBecause education level is highly correlated with health.
- Quality support for pregnant women and babiesTo dramatically reduce maternal mortality and give babies a good start in life.
- Social support for the elderly To end loneliness and isolation, which are major causes of debilitation.
- Ending Gun Violencedestroying too many lives.
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