[ad_1]
TIME TO RETHINK HEALTH AND HEALTH CARE
Introduction: A Wake-Up Call
In late January, the Institute of Medicine’s committee 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 the capacity 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.
Real Wellness
While we spend far more on medical care than all the rest, we are far less healthy. In what is arguably the ultimate measure of consequence, namely, quality of life, we are the Mississippi of advanced nations.
What are the prospects for American health in times to come? To paraphrase Lewis Pasteur, chance favors prepared minds and fit bodies. Thus, at present the odds are long against Americans. Too few of us even recognize that there is more to health than not being sick. Those of us who embrace REAL wellness or anything like it have a mission, though most of us are too modest to mention it: to influence everyone we can. Influence how, you ask?
To beg the question for a moment, I’ll answer my own query thusly: In any and all ways that seem to offer any promise at all to improve the chances that more Americans will somehow manage to bend high level health status odds in their direction. For too many, the chances at present for even thinking about, much less realizing, REAL wellness lifestyles are comparable to their lottery prospects.
Doing so requires an appreciation of the reality that there is a state of exuberant well-being. That is, there is more to health than most think. A better state of well being can be approached and enjoyed, not by continued dependence on medical ministrations and even wonders but on lifestyles guided by accessible skills – including but not limited to effective decision-making, joy in living, athleticism, perspective and personal freedoms.
A Better Way of Thinking about the Nature of Health
Dr. Dean Ornish and others believe that at least 75 percent of the $2.1 trillion dollars spent on health care costs last year were for chronic diseases that are largely preventable. Most are also reversible just by diet-focused lifestyle reforms, but few seem able to manage even this much of a shift from the normal and customary American way.
Health reform even with the Affordable Health Care Act will fail if the emphasis remains on who is covered rather than on what is emphasized by doctors and others and what is covered by insurance. We need less health insurance reform, more human being reforms. We need to focus on how the nation can become a healthy society. Not healthier! That implies we’re already healthy. We’re not.
Make no mistake. Those of us with sufficient access health care enjoy good medical attention if and when we really need it. But, so much has to be done in order that most Americans will not need so much medical attention. This applies to normal care in the early and middle years of life, as well as later when super-duper institutional and medicinal resources are brought to bear on chronic conditions that have set which limit quality of life possibilities.
REAL wellness promoters and all who seek a healthier society (beyond a well-medicalized one) might want to adopt a bold new goal – guiding Americans toward healthier outcomes.
Naturally we need medical care on occasions throughout our lives, no matter how wisely we live. But we need to live wisely all the time, throughout life, before we eventually die as healthy as possible.
We know that the fundamental causes of chronic diseases are primarily related to lifestyle choices expressed daily. We can’t avoid these problems with drug and other health care interventions; medications and surgery are palliative remedies for symptoms of failed lifestyles.
Bottom Line
In plain language, we’re in a fix. What must be addressed if we want to change? Here’s a partial starter list:
* The kind of foods and liquids we consume.
* The emotions we generate.
* The feelings we endure.
* The irrational and toxic chemicals we process through our lungs/blood and important organs – and all organs all important.
* The discipline to exercise every day.
* The artfulness for successful relationships.
* The social supports that can reinforce good choices, and
* The discovery of practical ways to help people find more fulfilling pursuits of happiness.
And so on. There are many more.
These lifestyle factors are examples of initiatives that could boost American health – REAL health, quality of life-enhancing well-being styles of health. These elements of REAL wellness are more consequential than the most skilled and expensive ministrations of fabulous teams of doctors and nurses, more important to health status than the world’s greatest medical institutions. They count more for quality of life than all the wonder drugs designed by chemical geniuses.
It’s not an either/or situation. Leaders in the medical system can emphasize the nature of health beyond the work they do helping the injured and sick recover from physical and mental adversity. They can do this while providing excellent medical care for illnesses, accidents and chronic failures.
Evidence-based medicine is good, far better than the dominant reimbursement – based medicine. Yet, medicine will not change the dismal reality of lowly health status for Americans. Only REAL wellness lifestyles will do that.
What will turn things around? What will it take to realize needed changes, including ways to motivate and support people willing to learn better skills to self-manage life’s challenges?
Who is better positioned to figure it out, little by little and bit by bit, than doctors and other medical professionals who work everyday with those who have ruined their health, as well as business and community leaders aware of the high costs of mediocre health status? The poor health quality of Americans is a condition of social, cultural, institutional and environmental factors that shape choices people make.
Ultimately, everyone must do his or her part, somehow, to live life wisely and well and find ways to help others do likewise.
I’ll end with a message somewhat presidential! Ask not what the medical system can do for you – Ask instead what you can do for your health, and what together we can do to enhance the health status of everyone else.
[ad_2]
Source by Donald Ardell