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This post was contributed by Robert Seligson, treasurer and board member of the Physicians Foundation and the CEO of the North Carolina Medical Society (NCMS).
The conversation about how best to reform our health care system has largely centered on the battle over legislation. But underlying the contentious discussion over who and what should be covered by health insurance and the cost is an often-overlooked aspect I contend is equally important to the health of our citizenry: the factors outside of the doctor’s office that help us stay healthy.
The conditions in which you live, whether you have transportation to a clinic when needed, your support network and other factors beyond the doctor’s office are as important to your overall health and well-being as being treated for an illness. Research has shown that while genetics certainly play a role, at least 60 percent of health outcomes are a result of circumstances outside of the health care system.
The late Dr. Buz Cooper illustrated the extensive impact social determinants play in overall health incomes in his book, Poverty and the Myths of Health Care Reform. He found that areas of the country where the rate of poverty was higher, including Appalachia and the Deep South, had the highest health care costs and experienced the highest mortality rates. In contrast, more affluent areas of the country like the Northeast and the Northwest spent less on health care and experienced lower mortality rates. Dr. Cooper suggests that if the United States focused on strengthening elements in the country’s economic and social infrastructure, this would help those living in poverty across the U.S., leading to healthier lives and less required medical attention.
A 2013 study by the Commonwealth Fund compared the United States with other industrialized countries’ spending on health care versus non-clinical needs. In all the other countries studied, more of the gross domestic product was devoted to what the study termed “social care” instead of “health care.” Interestingly, on measures of population health, like infant mortality, prevalence of chronic conditions and life expectancy, the United States fared worse than our international peers.
This is clear evidence that the problem of the American health care system does not lie in the fact that there’s a gap in health care spending in the United States. Ultimately, it’s the socioeconomic conditions including income, education and social status that are the major game-changers when it comes to health care outcomes.
As CEO of North Carolina Medical Society (NCMS), I’ve seen awareness building around the importance of addressing non-clinical factors. First, those involved in caring for people both in and out of the clinical setting are breaking down the boundaries that used to separate us. NCMS, specialty medical societies, health systems, community organizations, patient advocates and the North Carolina Department of Health and Human Services (NCDHHS) are collaborating on ways to best serve the needs of the patient both inside and outside the medical setting. North Carolina has an opportunity to be held up as a national example of how to build coalitions to address these needs while improving access to quality health care and reducing costs.
Similarly, the Physicians Foundation is committed to addressing the important social determinants that are driving health care costs in the U.S. and negatively contributing to poor health care outcomes. For years, the Physicians Foundation supported Health Leads, a national health care organization that connects low-income patients with the basic resources they need to be healthy. The Physicians Foundation also seeks key conference speaking opportunities to discuss the important role that social determinants play in health care.
Successfully improving health while reducing costs also depends on innovative payment and care delivery models – no small task and one we are all grappling with as our health care system undergoes much needed change. Research data shows, however, that continuing to ignore the impact of unmet environmental, economic and social needs relegates patients to adverse health outcomes throughout their life.
Strong leadership and initiative are needed nationwide from physicians and hospital systems and every concerned group and health care professional with a stake in and the professional responsibility for our health care system.
