If Health Is the Priority, Prove It

Should optimum health status for each person and the population be the top priority for the nation, as the body politic proclaims, then every public policy must be examined for its impact upon that goal. Health status is dependent upon much more than medical care, especially if it is to be the best health status possible. Education, economic well-being, agriculture and food supply, physical activity, the environment, energy and the climate are vitally important for achieving optimum health status for the population. Every priority of the nation depends upon optimum health status of the population and achieving optimum health status depends upon every basic, essential priority of the nation. All nations must guard against the inevitable and constant drift and steady dilution that occurs in the process of establishing and maintaining essential priorities based upon national values. Now is the time to prove that optimum health status is a the top priority for the nation and accept that more medical care is not the answer for achieving that priority.

Bells and Whistles

Treat the patient, not the CT scan. Right on, Dr. Verghese. You are correct and I admire your idealism. But treating the data rather than the patient is a time honored tradition in our technologically oriented society. People expect bells and whistles. Search and destroy, shock and awe, find and fix.

Multiple Chronic Diseases

Patients with multiple chronic diseases are a growing problem. These people are treated with multiple drugs directed at each of the diseases. The treatments may work at cross purposes and the best that can hope to be accomplished is to slow the overall deterioration of health status. Almost always the situation is the result of various degrees of unhealthy lifestyle and it is rare for someone at this stage of illness to reverse themselves. I admire Jane Brody's observations on the matter but multiple chronic diseases in a single individual bring out the worst in the medical care system plus a sad realization of the neglect of lifestyle in health care.

Transformation

Transformation is a powerful force whose source and course is less predictable and less likely to be planned than reform. Individuals and society struggle to keep up with transformation, which yields a new direction or a different way of accomplishing something or a different goal. Transformation is rare and it does not depend upon reformers who attempt to adjust existing systems.

To achieve the best health status possible for individuals and the community will be disruptive and the process will have to be creative and persistent beyond the wildest imaginings of today's reformers. And good luck with all the economic enterprise that has grown wealthy serving and abetting sickness. Don't be surprised they resemble Wall Street bankers with a bit more arrogance and even less contrition. A culture oriented to sickness is sapping the biological and economic vitality of the nation. Changing this culture is above and beyond medical care reform.

More Health For the Care

The body politic and the medical care industry are not without honor but they cannot achieve optimum health status or cost containment by manipulating health insurance or reforming medical care. It is a matter of priorities. Health must be emphasized above sickness. Even what is considered successful treatment of a disease does not yield the health status prior to the disease. Furthermore, illness, disease, injury and disability will always be costly. It is best to avoid them, if at all possible.

More health for the care can be achieved by placing emphasis upon primary prevention integrated into all aspects of community life. Every institution and organization is involved and responsible. A public health care system will monitor and address health status in the community. Primary care medicine that is oriented to individual and community health will be the first responders to sickness. Linking and coordinating these activities depends upon educating the public and providers alike. Everyone needs health care, medical care is for those who need it.

Transforming the Culture of Sickness

Americans expect so very much from medical care. That is a problem because medical care provides some relief from sickness but few cures. On the other hand, healthy lifestyle can prevent as well as reduce the severity of many chronic diseases. But people's judgement and resolve is clouded by their faith in medical care. Thus, medical care is a process that continues to grow in amount, level of intervention and cost without achieving optimum health status. Governments contribute to the situation by expanding medical care but they do very little to actually reform medical care or achieve optimum health status.

It is possible to reduce the need for medical care by 50 percent if everyone pursued a healthy lifestyle and medical care was better organized. And it would be value added as the health status of the nation would improve. The purpose is not to take away something but, rather, to add to the quality of life by redirecting attention and effort to a more effective means of achieving optimum health status. People need to be inspired and motivated to achieve and maintain their optimum level of health.

The role of leadership is to create a vision, establish a goal and outline a pathway to achieve the goal. The President must advocate a vision of a more healthy population and establish a goal of reducing the need for Medicare and reducing Medicare by 50 percent over ten years. This is to be achieved by a more effective, efficient and ultimately smaller medical care system plus a community based public health care system that promotes and maintains healthy lifestyles. To illustrate the point, reforming federal agriculture policy would do more to improve health status of the nation than manipulating health (medical care) insurance could ever accomplish. Governors should follow suit with a goal of reducing the need for Medicaid and reducing Medicaid by 50 percent over ten years.

Reducing the need for Medicare and Medicaid and reducing Medicare and Medicaid by 50 percent over ten years is a goal comparable to the one in the 1960s of putting a man on the moon. Now, that would be leadership. And it can be done. Americans do not want to be sick but they have been taught to fear sickness more than to trust the pursuit of good health. They need to be led out of the medical care wilderness into a health care world.

Health Is A Community Affair

Achieving and maintaining optimum health is a philosophy; a way of life; a lifestyle. It means commitment to the best health possible for each individual, every family and the community. It starts with individuals giving careful and continuous thought to the concept of health for themselves and the community. Education, personal and community values, belief systems, art, religion and spiritual life prepare individuals for this task. Health is a community affair and artful living.

Dr. Albert Schweitzer proposed that civilization depends upon the spiritual and ethical development of the individual and the degree of worthiness of its individual members. Socioeconomic culture plays a role through the influence of personal interaction and the impact of business and finances on choices and decisions. Good health is as much a group activity as it is individual responsibility. The thoughts and ideas of a society determine what actions the society performs.

Fear of Sickness

In lieu of defending medical care, I offer a commentary on health and sickness, health care and medical care, and a health system. These views and comments come from seventy-two years of life experience and fifty years of life actively involved in medicine and health. I have learned that a health system is a basic aspect of community life. The goal of a health system is the best health status possible for each person and the community. Medical care is a component of a health system and not the first or necessarily the most important component. When a health system is usurped by medical care or medical care is in the primary position, it reflects a mind-set that fears sickness more than it trusts the pursuit of good health. That mind-set relies upon medical care to cure sickness but it is not a mind-set to prevent sickness.

If You Build It, Will They Come?

Changing behavior is so much more difficult than relying upon the expectation that medical care will save the day and health insurance will pay the bill. But medical care has few cures and provides inadequate relief for the rising tide of chronic diseases that are secondary to unhealthy lifestyles. The difficult process of modifying lifestyle is inhibited by the orientation and excessive reliance upon medical care. Balance in a health system is a challenge but it is necessary to achieve optimum health status and avoid escalating costs. The essential ingredient is an informed and inspired public who are engaged in healthy lifestyles.

Medical care has too much invested to lead change or change. The politicians don't have a clue as they keep trying to reform health insurance. The insurance companies are wise to the situation as they collect premiums and slowly, reluctantly pay claims. Everyone is acting in their own best interest except the patients and the public and they are paying an awful price.

"If we've learned one thing about behavior change over the past 50 years, it's that knowledge is not enough to bring about change," said Laura Carstensen, director of the Center on Longevity at Stanford University. "Humans are exquisitely sensitive to environments. If there are mostly fast food restaurants in their neighborhoods, they eat fast food. If there are safe and appealing paths, they take walks. We must begin to think seriously about building environments that encourage all sorts of healthy behavior." (Karen Stabiner, New Lives for 'Dead' Suburban Malls, New York Times, January 21, 2011)