In "A road map to healthier populations: Where we are," the first in a four-part series, Ram Raju, MD, senior vice president and community health investment officer, looks at the current state of health care.
What is the role of community health?
Why are we not in the top decile of developed countries for health outcomes? Why is the infant mortality in this country so high? Why do more people suffer from chronic disease in this country? Why is nearly one-third of our population obese. If you look at all of these glum statistics, we know that we are not achieving the results or outcomes for the amount of money we are spending in health care as a country.
As we scratch our heads to understand why we are not getting the outcomes we’re supposed to get from the amount of money we are spending, we realize that the fundamental reason is that for a long time they (health care and social services) did not work together and were mutually exclusive. Our goal is to link together health care and social services to keep the population healthy.
Why are we in this situation?
The health care we are providing is great, but not smart. We have very smart people who work in health care trying to figure out where the disconnect is. What we have come to realize is that health care cannot be delivered in isolation anymore. It has to be delivered in conjunction with other social determinants of care: things like housing, transportation, recreation, exercise, healthy food, economics and education. All these things need to come together for communities to access appropriate health care and most importantly realize the benefits of that health care. Just because we offer health care, does not mean people are benefitting from it. It’s a two-way street. The goal is to get patients to use health care smartly and efficiently…to understand the impediments to the access and correct them. That is the job of the health care community and it is the job of social service organizations. What we are attempting to do is make them work together.
How do we make our populations healthier?
Nothing worthwhile is easy. This is not a project or a timeline. This is a movement. We can’t just improve the health of a population without addressing the other factors that are intertwined with health outcomes. We cannot look at health care by itself. What social service organizations need to understand is that health care cannot be delivered in isolation. Similarly, health care leaders cannot just be health care ‘doer’s or caregivers — they have to be social change agents…they need to advocate for better health.
People within health care may ask ’how do I do this?’ My expertise is to deliver health care. They have to look beyond the task at hand. Health care systems and their leaders have a lot of clout, a lot of leverage — they should learn how to leverage it. As health care leaders, we have economic leverage. We are often the major employer in the surrounding community where a hospital is located. We create jobs. We support local economy. We have political clout in the community, we have social influence. We need to use our clout to create an environment where people can live healthy. Pouring more money into health care systems for greater access without addressing these social issues is like filling a water tank with holes in it. You can keep pouring money in — we now pour $3 trillion into the health care delivery system in our country…but we will never get the results we deserve unless we plug the holes first. We need to figure out how we do this in an effective and collaborative way.