Health vs. Health care

Did you see the string on X [formerly Twitter] this week about the neurosurgeon quitting the US healthcare system? A link to it landed in my inbox for comment.

The neurosurgeon quit after 10 years of practice because he realized that many of his patients needed lifestyle changes more than surgery. Rather than lifestyle changes , patients are reportedly being treated with pharmaceuticals and surgery because that’s how healthcare system gets paid.

The US healthcare system and many other systems deliver “sick care”. No one is going to deny that, however there have also been a number of initiatives to encourage prevention and support healthy living over the last several decades. For instance, Health Maintenance Organizations [HMOs], Kaiser’s Thrive your Way jingles , Accountable Care Organizations, Public Health guidelines, warnings, restrictions and more are all designed to encourage prevention and healthy living.

Is it enough or did the intent resonate with the public? Evidently, not or these types of strings on social media wouldn’t get much engagement and the stats would tell a very different story.

Health vs. Health care

According to Axios , there is wide acceptance within the healthcare industry that a person’s life circumstances affects their health but there is also a budding disagreement over who's responsibility it is to do something about it.

Social determinants of health have been top of mind for years as healthcare systems and payers experiment with different ways to curb the cost of healthcare. The industry seems to have arrived at another quit or grit decision because no one has uncovered a good solution. Hence the debate now about whose responsibility it is to address the social determinants of health.

What are the social determinants of health?

According to the US Centers for Disease Control and Prevention, there are five determinants of health: healthcare access and quality, education access and quality, social and community context, economic stability and neighborhood and built environment.

The government of Canada identifies twelve determinants of health: income and social status, employment and working conditions, education and literacy, childhood experiences, physical environments, social supports and coping skills, healthy behaviors, access to health services, biology and genetic endowment, gender, culture and race/racism.

Who gets rewarded?

Everyone is rewarded when your community, city and country has a healthy population and productive workforce. It attracts new investments and spurs growth which is why governments often implement policies and programs to support the social determinants of health in communities, organizations and homes.

Conversely, a lack of population health makes a community less attractive for investment and can compromise your personal safety, health and freedom. If you’re not convinced, take a few minutes to answer these questions:

1/ Do you feel safe walking alone when it’s dark?

2/ Do you have people camped outside your home and/or workplace in tents, motorhomes or lying on the street?

3/ Do you have a gate, security cameras and locks on your doors?

4/ Do you feel safe sleeping with your windows open at night?

5/ Do you live in community with a vibrant downtown or is it changing?

6/ Can you walk into a corporate office without clearing security?

Is health and wellbeing an employer responsibility?

In short, no. However, it is in their financial interest to provide the resources necessary to support employee health and wellbeing now and in the future.

The latest stats from a number of sources this week including JUST Capital, B Corporations and reports on employee wellness initiatives are all positive. According to Bain, companies prioritizing high value creation for customers, employees, suppliers and communities [aka: stakeholder capitalism] are also delivering a significantly better financial return for shareholders.

Some of the fundamentals that companies have to get right to address the social determinants of health are workplace culture , compensation and benefits including paid time off. Beyond that leading edge companies realize now that wellness impacts every part of life. As a result, wellbeing programs at these companies incorporate mental health, financial health, social health, community health, spiritual health and more.

What is the role of the individual?

Unlike many other developed countries, US policy places more onus on the individual to make decisions and provide for themselves. People interpret that responsibility as personal freedom.

If we’re learned anything from the Covid pandemic, it is that personal freedom needs to be honored whenever possible. In the context of healthcare and social determinants of health, patients need to be empowered to choose their care pathway.

Some may choose lifestyle modifications and to address their social determinants of health whereas others may choose “sick care” and prefer to be medically managed. It may or may not be ideal but it’s what they choose at least in that moment.

Clarifying the distinct pathways of care [social management vs. medical management] might be a good way to empower patients to make their decision. I'd love to hear your thoughts on that idea in the comments.

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