An anonymous physician wrote the following. With his permission I have edited it for length and clarity:
If you are a current or future patient or a healthcare worker, you should understand the concept of “population health.” A recent Medscape video describes this important way of thinking about health and healthcare in America today.
According to the author of the Medscape piece, Dr. David B. Nash, medical care as we practice it in the U.S. only accounts for 15% of the health of the population. Personal behavior, environment, and genetics constitute the remaining 85%. We all are familiar with the importance of personal behavior. Smoking, alcohol consumption, obesity, bad food choices, and lack of exercise cause 50% of poor health outcomes. Only 3% of the population avoids all these bad choices. The Medscape message is that doctors are going to have to do more to convince patients to behave properly for the health of our population to improve.
How are we going to achieve this goal? The public health literature has been dealing with this critical question for years. In the public health way of looking at things, the non-medical care issues that affect health are collectively referred to as “social” determinants. Public health officials believe that people are “driven to abuse their bodies by their social environment.” Merely telling patients to live a healthy lifestyle won’t cut it. Too many factors outside their control influence people to do unhealthy things.
The Robert Wood Johnson Foundation has published many documents describing the social factors that need to be remedied before Americans can embrace a truly healthy lifestyle. What are these factors?
Here are a few: adequate housing, crime, clean air, transportation choices, good schools, educational achievement, smoking, drinking, illegal drugs, personal stress, access to vacations, healthy and safe sex, supportive communities, high personal incomes, income equality, healthy food, obesity, racism, seat belts, good jobs, and my favorite of all—living in the right zip code.
Yes, good health for all means creating a better world, a better society. Is this the new job description of a physician? Perhaps so. Dr. Nash praises a hospital for going down this path by growing food for its patients.
To what extent do these social factors lead to reduced access to traditional healthcare services? The justification for the Affordable Care Act was the need for better access to medical care, not to provide for more playgrounds or air-conditioned housing to improve healthcare “outcomes.”
In truth, the lowly 15% figure for the effect of medical care on population health is impossible to verify. One way it could be done would be to conduct a trial. Allow half the people in Iowa to have access to medical care for 15 years, the other half none, and then see the results. Of course this will never happen.
But assuming the 15% figure is correct, should we wonder about the billions of dollars being spent on medical care “outcomes” research when social factors have far more influence on outcomes?
Can doctors take us to the new utopia of healthcare? Should they be expected to? Isn’t this really a political choice?