Health:The Crititcal Piece of Reform

Health: The Critical Piece of Reform

Couldn't agree more that prevention needs to be a vital part of health systems. If you have a suggestion for which health system has succeeded best with it, would love to see it. But the VA and Kaiser systems have done a far better job on promoting health of its members than others. Haven't seen any that do it spectacularly well...   Atul Gawande, MD

 Dr. Gawande:

Thank you for your considered response to my blog article: No, You Can’t Get There From Here.

However, disease prevention and the promotion of health will never come from care-based delivery systems whose financial viability depends on diagnosing and treating disease.

In fact, even if they did, their primary tactic of patient education just does not work. Almost all, if not all, people know that smoking is bad for their health, that unprotected sex may result in AIDS, that diet and lack of exercise cause obesity, diabetes and heart disease and death. Yet, sadly, it does not change the behavior of most.

We live in a contradictory world, where the scientific evidence is convincing but the corporate influence (advertising, product placement, lobbying, etc.) is overwhelming.

Historically, most of the major advances in population health came from public health policy initiatives such as improved sanitation, plumbing, smoking bans, seatbelt laws, etc., and not from medical disease ‘cures.’  To believe otherwise now, to discuss national health plans and unified payers or, what should most accurately be called Health Care Finance Reform, as the fix to this pandemic health crisis is both misguided and dangerous. It is treating the symptom and not the cause.

I agree that we need to address the symptoms of costs and access, and I look forward to the inception of national health insurance that includes wellness care and incentives to promote subscribers’ health.

However, the reason I write is to urge you, and other people of influence, to change the dialogue from health care finance reform to public policy discussions to dramatically alter the course of this deadly health crisis.

Much like the pressures brought to bear on the auto industry to make cars safer, we need to exert similar pressures, enact legislation and add taxes (among other measures) to limit access to, and availability of, cigarettes, alcohol, junk food and fast food restaurants; pushing people towards healthier choices.

There are many simple steps that can be taken. As Michael Pollan and others have suggested, the government can subsidize and redefine real and healthy foods. Non-foods would be taxed; at one and the same time creating a subtle awareness of food choices,  financial incentives to buy healthier foods, and tax revenue to support other health initiatives.

We need to limit, or outright ban, political lobbying by pharmaceutical companies. We need to immediately ban direct to consumer advertising of drugs and the associated disease mongering.

There is so much we can do if we stay focused on the right goals.

Thank you again for your time.

Peter D. May, DC CCWP