I have a question for everyone. Do you think the American healthcare system is making us healthier at a population level?
One of the sexiest topics in academic medicine are the social determinants of health. Basically, if you are poor, your chances of having adverse health problems go up tremendously. Some of the reasons for this are:
- Reduced access to quality education regarding life and health
- Reduced access to healthy food, gym memberships, and lifestyle improvement programs
- Neighborhoods with higher burdens of pollution, less green space, and more crime
- Increased rates of substance abuse
- Housing instability
- Limited or no access to healthcare
- Discrimination from the rest of society
All of these factors combine to make the area code you grow up in, more important than your genetic makeup with regards to health. This is a major problem without a doubt.
But there is a dark side to all this. In the United States, healthcare bills are the biggest cause of bankruptcy for both individuals and companies alike. As such, healthcare is the largest force behind poverty in our country.
We act like access to healthcare is so important. However, I would argue that financial security is much more important to the health of a family than access to health insurance. When we undermine financial security in favor of access to healthcare, we inevitable expose more families to poverty.
It becomes easy to see how this becomes a toxic cycle. As a doctor. I know that I am a huge part of the problem. Healthcare is pushing more people into poverty than ever before. People are getting sicker as a result, and subsequently cannot afford or access care.
To break this toxic cycle, society needs to get real. The answer to our increasingly unhealthy population is not bigger hospitals, expensive new technologies, or giving people handfuls of drugs to take every day. The answer is a focus on the actual drivers of health. Namely:
- education and better health literacy
- improving the physical environment in which we live
- healthy personal finances
- good behavior/choices.
Access to healthcare is at the very bottom of the list as a driver of health.
Healthcare should stop patting itself on the back so much. We are perhaps the largest driver of unhealthiness. Additionally, healthcare acts like it has a pass on pollution, further undermining the health of the physical environment we live in.
This is why I cannot spend my career working in status quo healthcare. This is why I started Wander Medicine clinic. Innovative ways to offer high value primary care at affordable prices that do not bankrupt people are desperately needed. Giant hospitals systems and astronomic healthcare bills are not making any of us any healthier.