“We have the science, we have the tools. We have to add in the commitment and the will,” Susan Blumenthal, MD, MPA, former U.S. Assistant Surgeon General, told the annual meeting of the Partners for Community Wellness (PCW). She called the effort to provide quality, affordable health care for all “the moonshot of our generation.”
“Much progress on the road to a healthier future has been made, but much more needs to be done,” she said in her keynote address.
Blumenthal, who was also the first Deputy Assistant Secretary for Women’s Health in the Health and Human Services Department and who is a clinical professor at the Tufts and Georgetown University Schools of Medicine, focused much of her address, titled “Tipping the Scales Toward Health: Transforming Community Care,” on strengthening community participation in health care to reduce what she called “health inequity.”
She said that despite the fact the U.S. spends 18 percent of its gross domestic product on health care ($2.9 trillion), the nation ranks just 26th in life expectancy compared to other developed countries, most of which spend 10 percent or less on health care. Since 2000, health care costs in the U.S. have increased 40 percent, yet Americans, she said, get the right treatment for their ailments and conditions just 55 percent of the time, and 50 percent of physician care is not based on best practices. “We are not getting what we pay for,” Blumenthal commented.
She said three lethal killers in U.S. — obesity, smoking and lack of physical activity — in particular are devastating the nation’s health. Despite huge decreases in the smoking rate among adults over the past 40 years, smoking still causes one out of five deaths in America. Obesity and lack of physical activity conspire to compromise the health of 68 percent of the population, she added.
“In 2012, nearly one in two Americans reported having a chronic illness,” she said. “Seventy percent of all disease in the U.S. is caused by environmental and lifestyle factors.”
She called the disparities in health care in the U.S. — which have been detailed extensively by The Dartmouth Institute for Health Care Policy and Clinical Practice — “shameful and profound.” Income and education levels are the most powerful predictors of health worldwide, she noted, adding that 14 percent of the U.S. population lives in poverty. “Poverty is a carcinogen,” Blumenthal stated.
“Health equity is not only a moral imperative, but also vital for the financial health and economic productivity of our communities and nation. Disparities for minorities and the poor cost the U.S. $229 billion in direct medical costs and $1 trillion in indirect costs between 2003 and 2006,” she reported.
“Because we’ve had a ‘sick care’ system, not a real health care system, we have to perform CPR — we have to breathe new life into the health care system by 1) Covering all people with quality care, 2) putting Prevention first, and 3) investing in Research,” she said. “We have to work together to design communities for wellness, where people can thrive — communities that are livable, safe and healthy. We need to emphasize aging in place for seniors. The result will be healthier people and economies. With a more efficient health system, cost savings can be invested in creating healthier communities.”
She said there needs to be more emphasis on prevention and called communities “the cornerstone for prevention. We need to engage families, individuals, businesses, policy makers and community organizations.”
Blumenthal, who is also the public health editor for the online publication Huffington Post and who is a senior fellow in healthy policy at the New America Foundation, and senior medical advisor for the Foundation for AIDS Research (AmFAR), told the PCW annual meeting that “good health is essential to the stability of families and communities, the development and sustainability of nations, and prosperity and opportunity for all. You can shape the future of health here in this state, our country and globally. What you’re all about, what this organization is all about, is charting a strategic vision for community wellness.”
Robert Greene, MD, MHCDS, FACP, Dartmouth-Hitchcock’s executive vice president and chief Population Health Management officer, followed Blumenthal’s keynote address with a description of what population health means in the context of today’s health system.
“We have two problems,” he said. “First, the current system is designed to succeed at fee for service, creating fragmentation and perverse incentives. Health care accounts for just 10 percent of health outcomes. We must work on the factors that account for 70 percent of the outcomes, and the context of those factors is the community, not the health care system. Patients with chronic diseases often have concurrent significant behavioral health issues and social needs, and that’s where organizations like PCW really come in.”
He said the needs of patients have changed “and the system does not meet these new needs,” adding that one of the big problems to solve is that the activities that are key to keeping chronically ill people are generally not billable in the present health care economy.
“Second, we need new partnerships working on the whole spectrum of health determinants – health behaviors, socioeconomic status, physical environment and clinical care,” Greene commented. “We need to understand the needs of different populations and develop innovative ways to efficiently and effectively provide care. And we need to focus on building sustainable systems to improve health now and in the future; we need to move from doing ‘projects’ and start building programs of care.”