PhD Student
College of Nursing
University of Utah
The Current State of Health in the U.S.
The United States has
historically been built upon a disease-care model rather than a
health-promotion model, and while our healthcare system has made some
remarkable advances in technology, genetics, and pharmacotherapy, we as a
nation have failed to address some of the most fundamental healthcare needs
that can promote physical, psychological, spiritual, and financial wellbeing;
factors that are directly related to better health outcomes and quality of life
for all Americans, both rich and poor. As a result, our country is now facing a
major existential crisis of what it means to live a truly healthy, productive,
and fulfilling life.
Figure 1. Pill bottle spilled. By M Pelletier,
2016, (Atlantic
Training), via Wikimedia Commons. Used under Creative Commons Attribution-Share
Alike 3.0
While the U.S. pays more for
healthcare than any other country, it greatly lags behind in almost every
measure of health grades. You may wonder how this is possible given the valuable
strides Americans have made in science and medicine; however, the answer is
relatively simple. First, one’s actual health status does not entirely depend
on advancements in healthcare, and second, even when the state of our health
becomes dependent upon innovative services that our system provides, many
Americans are unable to access needed treatments, let alone basic care, or they
may get help too late or experience poor quality health care.
What
Has Been Wrong with Healthcare and Still Is: Health is a Sociopolitical Issue
One of the major health-related issues that
many Americans face on a daily basis is a general lack of access to healthcare.
The U.S. falls behind almost every other nation when it comes to basic access
to care. With approximately 45 million U.S. citizens (not to mention the
millions of immigrants and undocumented workers) suffering from being uninsured
or underinsured, poor health outcomes are a real and impending risk.
Figure 2. Percentage of US
adults 18-64 years old without health insurance in 2009. By CDC, 2012, via Wikimedia Commons. Used under Creative
Commons Attribution-Share Alike 3.0
Another important social issue that directly
threatens adequate health status for a large portion of Americans is directly
caused by lifestyle factors. Lifestyle and health status, consequently, are
intimately connected to social determinants of health, such as reduced
healthcare access, ability to consume healthy food, clean air, and live in safe
neighborhoods. Moreover, a disadvantaged lifestyle has been associated with
poor health status due to lack employment opportunities and the skyrocketing
cost of healthcare. These types of disparities leave many Americans vulnerable
and with limited options for care. As well, the stress that accompanies poverty
can greatly effect an individual’s ability to adopt a healthy lifestyle and
mitigate health risk factors associated with a poor diet, lack of exercise, tobacco use,
and excessive drinking—coping strategies for increased stress.
The current decline in the U.S. healthcare
system is, to a large extent, the product of two basic aspects of the U.S.
political economy. One of the major contributing factors to a weak U.S.
healthcare system stems from disadvantaged Americans lacking a voice, “a seat
at the table” in the healthcare, political arena. Consequently, this
population’s issues are often overlooked and under-represented in healthcare
policy and reform. Secondly, the U.S. government still plays a minor role in
health policy for each of the states. Health-based organizations and agencies
have been fragmented and weak in effecting change for population health. As
well, health-based agencies and various network organizations have been criticized
for being disconnected from the actual delivery of health services. These are
only a few contributing factors cited for what is wrong about the U.S.
healthcare system today.
The willingness of healthcare providers and
patients to tolerate large, health-based inequalities (such as gaps in income,
wealth, education preparation, and housing) has many unforeseen future health consequences.
Yet, until we are truly willing to transcend this old paradigm of a reactive,
disease-focused, model to proactive, health-focused model, the average
health-related quality of life will continue to suffer.
Time
for a Paradigm Shift from Sick-Care to Health-Care…For All
So,
what if our healthcare system actually kept us healthy? What if instead of
mostly focusing on restoring health, the U.S. healthcare system did as much, or
more, to prevent disease? These salient, provocative questions have recently
been proposed in a 2012 TED Talks (https://www.ted.com/talks/rebecca_onie_what_if_our_healthcare_system_kept_us_healthy?language=en) by Rebecca Onie, CEO and
co-founder of Health Leads, “a social enterprise that envisions a healthcare
system that addresses all patients’ basic resource needs as a standard part of
quality care” (https://healthleadsusa.org/). In this 2012 TED Talk,
Rebecca challenges her audience to consider that the question is not what
patients need to restore health, but what patients need to be healthy.
A
Little Background…
Figure 3.
Rebecca Onie Health Services Innovator, By Photo by Gail Oskin, 2009, (WireImage),
via
Wikimedia Commons. Used under Creative Commons Attribution-Share Alike 3.0
Rebecca
became frustrated during her internship with Boston Legal Services when she had
an “AHA moment” and realized that, over the course of 9-months of her work at
this agency, the families she was trying to help to secure adequate housing and
resolve unemployment issues actually had underlying, complex social, political,
and health issues that needed to first be addressed. She realized that the help
she was giving was “too far down stream” for her clients who showed up already
in a state of real crisis.
This
realization was further accentuated later during her 6-month internship in a
pediatric unit at Boston Medical Center where she had the chance to see
patients and parents in crisis every day. She began to question physicians in
this center over the next 6-months, and asked them, what she considered then, a
naïve but fundamental question: “If you had unlimited resources, what is the
one thing you would give your patients?” Surprisingly, or not so surprisingly,
many physicians told her that he real issue was that there’s no food at home. Children
we see are living in impoverished conditions, and there are is nothing we can
do. We have no connection to social services, and we have no time to address
these real issues.
The
Big Question?
“If
we know what it takes to have a healthcare system instead of a sick-care
system, why don’t we just do it?” (Onie, 2012).
Thus,
Health Leads was conceived out of a need to support physicians and healthcare
providers in connecting patients to real resources they needed to not only get
healthy but to be healthy.
The
Big Idea?
Rebecca
realized that if Health Leads could support physicians in writing prescriptions
for the real health needs of patients (prescriptions for food, heat, and other
social services that have a real impact on the underlying causes of sickness
and disease) that the current system could truly be transformed into healthcare for the disadvantaged—care
that extended beyond treating the immediate physiological diseases presented in
the four walls of the clinic. In fact, she found one way that healthcare could
address the basic sociopolitical determinants of health and quality of life for
disadvantaged populations.
Other
Shifts…
The
innovative work of social health entrepreneurs like Onie have revolutionized
the way we think about and look at health care. However, previous alternative
approaches to healthcare such as complementary and alternative medicine (CAM)
have been around since antiquity. Yet, given the current rise in health
disparities and chronic diseases in the U.S., CAM therapies are gaining new
attention, respect, and relevance.
What
Can CAM Do for this Shift?
Figure 4.
Massage hand , 2010, By Lubyanka, CC BY-SA 3.0,
https://commons.wikimedia.org/w/index.php?curid=10940918, via
Wikimedia Commons. Used under Creative Commons Attribution-Share Alike 3.0
Holistic and health promoting interventions
and education are integral to CAM, and certified CAM practitioners (i.e.,
acupuncturists, chiropractors, and massage therapists) are well-equipped to
work alongside traditional physicians in providing patient-centered care that
includes spending more time with patients to solve complex social and health
issues. Moreover, CAM practitioners see the value in advocating for lifestyle
changes that are conducive to promoting improved health and quality of life for
patients. CAM practitioners also may reach patient populations that traditional
practitioners miss. This is due to the idea that uninsured patients of lower
socioeconomic status may seek out CAM providers as a fee-for-service model.
Some patients may also seek CAM providers due to ideological beliefs about the
benefits of CAM therapies versus traditional interventions. So, including CAM
providers as part of an interdisciplinary healthcare team has emerged as a new
concept for promoting holistic health and wellness over just treating disease
among the U.S. population.
Barriers
to Shifting from a Sick-Care to Health-Care Model
A
recent article in the New England Journal of Medicine (http://www.nejm.org/doi/full/10.1056/NEJMp1206230#t=article) argued that health promotion and a
focus on health-related quality of life have become a topic of much discussion
in health policy circles as of late. However, implementation of this new
paradigm in U.S. healthcare is not without barriers. Economic and logistical
issues plague this change. For one, the current model of care is a task-based
model that pays physicians in numbers of “sick visits” per hour. This system is
prohibitive of increased time spent with patients and decreases the ability and
likelihood that physicians will take the time it requires to educate patients,
connect them to outside services, and generally promote nonpharmacological
interventions for improving health and preventing disease. It all comes down to
money and time. Another formidable obstacle to leap is our current reliance on
expensive technological procedures that add cost to care but may do little to
promote health and wellness.
Finally, as mentioned earlier, the current
healthcare system continues to reduce access to quality care for disadvantaged
Americans—perpetuating social and health disparities that reduce the chance for
patients to obtain basic, primary health needs. Finally, as mentioned, lack of
cohesive and direct government policies that advocate for health promotion at
every level continue to present difficulties in transitioning into the new
paradigm for health-based care. And finally, patient lifestyles and health behaviors
diminish potential for true health promotion and disease prevention—which are
perpetuated by sociopolitical disparities among many lower income patients.
Future
Directions
Recent efforts toward healthcare reform has
brought forth modest improvements thus far. However, future prevention and
health promotion will necessitate more profound changes such as the integration
of preventive interventions the management and delivery of healthcare. Change
is possible but not without addressing identified barriers and providing
practical solutions for integration of new innovations and outside therapeutic
modalities into the traditional system. Moving forward will require that we as
a nation address health needs and health disparities at multiple levels. This a
complex issue that will require a multidisciplinary approach as well real
health policy reform that addresses the healthcare needs of the disadvantage
populations of our nation.
References
Sierpina, V. S., Sierpina, M.,
Loera, J. A., & Grumbles, L. (2005). Complementary and Integrative
Approaches to Dementia. Southern Medical Journal, 98(6), 636-645
Schroeder, S.A. (2007). We can
do better-improving the health of the American people. New England Journal
of Medicine 357, 1221-1228. DOI: 10.1056/NEJMsa073350
Thompson & Nichter (2015).
Is there a role for complementary and alternative medicine in preventive and
promotive health? An anthropological assessment in the context of U.S. health
reform. Medical Anthropology Quarterly, 30(6), 80-99. DOI
10.1111/maq.12153
Links to Resources
Health Leads:
New England Journal of
Medicine:
TED
Ideas Worth Spreading:
Photo Credits
CDC. (Photographer). (2012). Percentage
of US adults 18-64 years old without health insurance in 2009 [digital image]. Retrieved from Wikimedia
Commons website: https://commons.wikimedia.org/wiki/File:Percentage_of_US_adults_18-64_years_old_without_health_insurance_in_2009.png
Lubyanka. (Photographer).
(2010). Massage hand [digital image].
Retrieved from Wikimedia Commons website: https://commons.wikimedia.org/wiki/Massage#/media/File:Massage-hand-4.jpg
Oskin, G. (Photographer). (2009). Rebecca Onie health services innovator
[digital image]. Retrieved from Wikimedia Commons website: https://commons.wikimedia.org/wiki/File:REBECCA_ONIE_12.JPG
Pelletier, M. (Photographer). (2016). Pill bottle spilled [digital image].
Retrieved from Wikimedia Commons
website:https://commons.wikimedia.org/wiki/File:Pill_Bottle_Spilled.jpg
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