Persistent health inequities, poor return on investment of health care expenditures, and the fragility of our nation’s health care infrastructure were amplified by the COVID-19 pandemic. COVID impacted us all, but especially persons of color and those with obesity and co-morbidities.
Concurrently, calls for racial justice illuminated health disparities and the ways in which our health care system is not equitable. Financial barriers to care, rising insurance premiums, high deductibles and co-pays all contribute to decreased access and lead to the avoidance or delay of services for health problems that only worsen when left untreated.
Despite spending almost 18 percent of our GDP on health care, Americans experience worse health outcomes compared to other countries. As a country, our disproportionate spending on the delivery of health care services, in lieu of greater investment in addressing social determinants of health, is a grave misalignment of national priorities.
We spend too much attention on treating disease rather than on the promotion of health. We must reconsider how we view health and commit to a more holistic and equitable approach toward health and wellbeing. We must commit to shifting our focus from disease management to health creation, including understanding health inequities and how social determinants of health contribute to worse health outcomes for many communities.
That includes understanding that health is more than just the absence of disease or infirmity. Health embodies the different ways an individual can live well despite illness and attain a sense of wellbeing regardless of their circumstance. Health includes physical, mental and social wellbeing.
Unfortunately, with longer lifespans and a significant proportion of Americans managing two or more chronic health problems, the idea of health as more than just the absence of disease is out of reach for many.
In fact, many Americans live in and have come to accept a state of unhealth.
There is a strong connection between behavior and health, and the impact lifestyle decisions and habits have on our wellbeing and disease risk. Boredom, anxiety, and conflict adversely influence our state of health and wellness, while healthy behaviors, like eating natural whole food, avoiding tobacco use, moving our bodies, getting quality sleep, stress reduction, and resiliency, are all modifiable and well-established behaviors that contribute to good health.
These types of healthy behaviors should be emphasized in health care education, financially incentivized, and supported by policies that make healthy decisions easy and accessible to all.
Our nation’s health care influencers, advocates and policymakers have an opportunity to redefine our approach to health care with a primary focus on health creation. Health creation requires a shift in thinking by health professionals, patients, and policymakers alike. Leveraging cross-sector collaboration and prioritizing social determinants of health (SDoH) are needed to address the economic and public health imperative of a sick health care system.
As Congress considers legislation which would recognize and codify SDoH as primary drivers of health outcomes, policymakers should consider the following recommendations to better align with health creation:
Reimagine health care priorities through allocation of greater public health resources to support health creation, particularly in communities of color. Confronting racism in health care — specifically as it relates to the health and wellbeing of the Black community — is critical. We must build trust, understand the values, experiences, and beliefs among persons of color, and recognize how systemic biases and social (dis)advantages influence the social determinants of health for various communities.
Revise health care communication and marketing to promote public health messaging that emphasizes patient empowerment, resilience, and wellbeing regardless of state of health or disease. We should also emphasize movement, healthy foods, proper sleep habits, and stress management as foundational to good health, while employing a more comprehensive strategy of health care delivery.
Reorient health care systems to prioritize health creation and use quality of life and wellbeing outcomes to measure system performance. Providers willing to deliver health coaching and lifestyle counseling should receive reimbursements. Care coordination and cross-sector engagement should be incentivized to decrease health disparities.
Aligning resources around health creation, emphasizing the fundamentals of health promotion, and enhancing collaboration can improve the public’s health and better meet the needs of communities who may have previously been disenfranchised by the health care system.
But, to do this, we need a paradigm shift away from disease care and toward health creation. While many efforts are underway to reform what is often referred to as a “broken” health care system, we must train our focus to the ways we can create health as well.
Michele Maiers (DC, MPH, PhD), executive director of Research and Innovation, Northwestern Health Sciences University.
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