06 Mar When Health Doesn’t Equal Healthcare, What Does It Mean?
Post Written By UMR Writer Haley Pysick
“Culture eats strategy over breakfast” states writer Peter Drucker. While cultural constructs help to develop the United States into its own unique society, it also stifles the development of new ideas and innovation from emerging. At the Transform 2014 symposium, Lauren Taylor, co-author of “The American Health Care Paradox” discusses discrepancies between health and healthcare, and how community-based initiatives can play a role in better health.
The United States is the largest spender on healthcare in the world, though when compared to other countries, it ranks alarmingly low in categories such as maternal mortality, life expectancy, and low birth weight. So the question is: why are we spending so much more on healthcare, while not getting any healthier? As it turns out, health care is only a fraction of what actually determines health. It is generally accepted that social, environmental, and behavioral factors are the largest determinants of health, while health care (and genetics) are significantly less influential.
Taylor argues that in order to have a healthier country, the focus needs to be placed on health at the community level. An historical example includes the Economic Opportunity Act of 1964. Part of the act integrated a new practice that established neighborhood health centers. The centers offered a complete range of health and social services available to people at every economic level. What was especially unique about these health centers was that they focused on health beyond a physical/biological perspective, and viewed it on a more comprehensive level.
As a result of the centers being creative at the community levels, the services provided were able to be personalized to each neighborhood’s unique needs. Even in the present, an idea like this is quite innovative and forward-thinking. However, once the project began to gain traction, fatal flaws were made in how it was handled: first, the program was moved out of the Office of Economic Opportunity (OEO)’s control. Then, its access became limited to people below the poverty line and split into primary and secondary care needs.
The primary care was basic healthcare, and was funded by the federal government. Secondary care, however, included all other services which were not funded (English as a second language, STD education, etc.). Taylor argues that by cutting these “non-essential” secondary programs, the government again made the flaw by asserting that healthcare = health.
In current times, there are measures similar to the Economic Opportunity Act, such as the Affordable Care Act and the Accountable Care Organization (ACO). ACO especially stands out as breaking the standard model for how health is perceived. A main goal of ACO is to go one step further beyond individual health, and set their sights on population health. When focusing on the macro perspective, other factors such as education, housing, and nutrition became more important to take into account.
However, most of the “measures and incentives” set forth by the Center for Medicare and Medicaid (CMS), are directly related to health care. In order to get reimbursement, ACO must report on those measures. While Taylor praises the effort to offer great health care, she argues it is still not enough in the bigger picture. Rather, our system continues to revert back to the issue of primary and secondary services, where only primary (healthcare) measures will be funded. This, in turn, stifles creativity for innovation of health beyond health care.
Fortunately, there are currently initiatives such as “The Way to WellVille” that focus entirely on innovative thinking in healthcare. These projects tend to do just what Taylor suggests: think broadly about health. This means engaging entire communities, from schools to businesses, about what it means to be healthy. Ultimately, Taylor claims that when the fallacy of health care = health becomes challenged, innovation for population health can occur.
Haley Pysick is currently a student at the
University of Minnesota Rochester, and an
contributing Intern Writer for the Center