The Disconnect Between Healthcare and Public Health


Recently my job and my passion for health and wellness came together for a brief moment in time and it was absolute magic. Not often does this happen to an accountant with a love for fitness and health, so let’s just say my inner nerd was really happy. While the actual event was not terribly exciting (I was taking an online continuing professional education course for my CPA license), the content, which covered our healthcare system, managing costs, and improving patient outcomes, was. Now that’s right up my alley!

Take a moment to imagine all the things in your life that impact your health on a daily basis. This list is pretty long right? It basically encompasses almost everything in your day, from how you sleep, when you wake up, what you eat, who you interact with, to how you feel and think throughout the day. It also encompasses the environment in which do you all of these things. These various aspects of our life are called social determinants, or more simply put, economic and social conditions that impact health.

They can be grouped in the following major buckets: where you live, what you eat (or don’t eat), access to transportation, education level, social network (family/friends), and employment and income. Studies have shown that approximately 80% of our health is determined by these factors. Makes sense right? In general, someone who is homeless and doesn’t have regular access to food, is relatively uneducated, and has no social support network will normally suffer from greater health issues than a middle class, educated individual who has a home, job, and family.

Here’s the catch. While social determinants account for 80% of our health, 88% of healthcare investment is in clinical care and doesn’t even consider these factors. This is a huge disconnect. As I have said before in my recent post on functional medicine, our medical system currently only treats the symptom, the clinical issue at hand. It does not take into account the other factors in a patient’s life that may be impacting their health in a big way, which are usually these social determinants.

Even if the system can treat an individual’s issue through care, who’s to say that it won’t come back again due to some other aspect in their personal life that is completely outside of the current realm of medicine? Maybe this person lives in a food desert and the only food they can afford and have access to is fast food. Maybe this person is super stressed out at their job and working long hours. Maybe this person is a single parent just trying to get by. The possibilities are endless and unique to each individual.

There are so many “ifs” and it is causing us money. In case you haven’t heard, we are a fairly unhealthy lot. We have the highest rate of of obesity among OECD countries (OECD stands for Organization for Economic Cooperation and Development). Obesity alone costs us about $245 billion a year. Add in cancer, heart disease, and Alzheimer’s and the numbers add up fast.

So what can we do about it? Focus on these social determinants. In my opinion, the best way to do this is through health coaches. Individuals who are trained in nutrition and healthy eating but also have an understanding of how all aspects of our lives impact our health.

Health coaches can work with doctors to implement a protocol based on each individual patient’s needs. Most importantly, coaches can provide ongoing help to individuals so that healthy changes are actually achieved, because we all know someone who’s gotten a recommendation from their doctor and never ended up following through on it. For those who need assistance with housing or other basic needs, they can team up with social workers and aid organizations.

I am imagining one big network of care that extends beyond the hospital or doctor’s office.

As I am a trained health coach I may be a little bit biased about how beneficial health coaches could be to the system, but the facts above really show that there is a need. Our current system is failing.

We are headed in this direction, slowly but surely. My health plan at work actually has monetary incentives that encourage you to speak to a coach about things such as stress, weight loss, and mental health. Maybe ten years from now health coaching will be an accepted thing that everyone uses and not just a niche thing for people with disposable income or a job that provides good benefits. I sure hope so, especially for those on the lower end of the income spectrum who sometimes need these services the most.

This post isn’t meant to be a sales pitch; I’m not actively practicing health coaching, nor do I really want to. It is meant to show the reality of where we are as a nation and where I think we are headed. That there are other avenues out there to achieving health besides going to the doctor and getting a prescription. Health coaches can assist you in finding health through areas that many doctors are not trained in, such as nutrition and exercise. They can be a great compliment to the work you do with your doctor.

If this intrigues you I strongly recommend you take a look at what coaching options are offered by your insurance plan and talk to your doctor to see if they have any recommendations. There are so many coaches out there that even a basic Google search will probably bring up a plethora of options.

Here’s to you achieving health in the way that works best for you!
Sources:  Deloitte Development LLC

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