As health care continues to be a top-ticket item for the 2020 presidential election, I've noticed that talk of reform overlooks one major stakeholder: the patient.
Some conversations about what's wrong in American health care frame the industry as an episodic, faraway realm we experience only when seeking, receiving or funding medical care. But so much of what determines health care are the hundreds of daily choices we make that decide the state of our wellbeing.
Pointing fingers is simple, after all. How easy it is to fault insurers, pharmaceutical companies, hospitals and government for any dysfunction that exists in the US health care system. A tougher topic to address is the fact that we, as Americans, have been complicit in causing chronic illness and driving up health care costs. It's much more awkward to look inward and question the lack of personal responsibility we take in managing our own health.
To be sure, our health is not entirely in our control. Some of us get ill because of circumstances beyond our control. We have no say over our genetic makeup, after all. Demographic factors compound everyday lifestyle decisions. What may seem like a straightforward choice to some may not be to others, depending on where they live, their family income, level of education, occupation and their social support network. Health care is becoming increasingly mindful of patients' genetic variants and the social determinants of health for better diagnoses and treatment plans, but we still have a long way to go.
Yet, even though these genetic and environmental factors are important, they don't change the fact that most of our health status is determined by our lifestyle behaviors and personal choices. Science backs this fact. A study published in JAMA Internal Medicine in 2017 found health-related lifestyle factors, including physical inactivity and cigarette smoking, accounted for 74 percent of the variation in life expectancy across US counties. The health care services that people received, on the other hand, accounted for only about one quarter of the variation.
If you use nicotine and tobacco, eat poorly, drink excessively, abuse drugs and don't exercise, you are on track for ill health. The vaping crisis affecting our youth is society’s most recent confrontation with a behavior at cross purposes with good health. E-cigarettes were first marketed as a safer form of smoking that could help people avoid traditional cigarettes, but they were never harmless.
Then the use of vape pens and flavored e-cigarettes exploded among children and teenagers. With savvy marketing tactics and confectionary flavors like mango, cappuccino and watermelon, it's understandable why approximately two-thirds of vape users age 15 to 24 do not know the product always contains nicotine.
Like the many public health threats before it, vaping has made its way into our physician offices, emergency rooms and intensive care units. Its trajectory was relatively swift, given that other unhealthy behaviors and choices can take years or decades before a medical intervention is necessary.
The vaping crisis troubles me deeply. An entire generation of kids face the possibility of addiction and long-term harm to their brain development and respiratory health. It also underscores how easy it is to compartmentalize health and health care.
E-cigarette companies are but one type of profiteers cashing in on Americans harming their health. Many food, beverage and spirit businesses do the same. And instead of facing fierce opposition or rejection, we accept these detrimental forces as commonplace. Equally troubling, politicians looking for an advantage in the polls continue to criticize health care while overlooking the lifestyle choices and lack of personal responsibility that are the primary reasons most people get sick and eventually end up needing medical care.
Do not mistake my call to action as a finger-wagging lecture. None of us are perfect. Even though I'm a health system CEO, I find myself in situations every day where the choices I make will either help my health or hurt it, and these are rarely automatic decisions. I wish I could tell you I make the right call every single time. Rather, I'm still working on it, growing more conscious of my choices and taking greater responsibility for my health.
After getting two heart stents, I went to a nutritionist and changed my diet, cutting out salt, sugar and foods that contributed to my heart disease. Fortunately, I’m now in reasonably good health because I got help in conquering what once felt like a formidable lifestyle change.
It might not gain any traction on the campaign trail, but health care reform is about more than doctors, hospitals and insurance companies. If we fixate on only one component of what makes for a healthy life, our reformation efforts will fall short. No health system has a mission to tell patients that they are to blame for their illness. But it should be our mission to take a more-aggressive role in empowering patients, helping them change their lifestyles and continually remind them that they have hundreds of opportunities every single day to choose a healthier future.
Let's do the best we can to be part of the solution, not the problem. We all have a role to play.
Michael Dowling is president and chief executive officer of Northwell Health, New York State’s largest health care provider and employer.
This op-ed appeared in Becker's Hospital Review.