This blog, the third in a series about our March 18 forum, Healing Health Care: Curing the System of Overuse, Underuse and Misuse, focuses on the “cruel paradox” that while we are spending more and more on health care, our overall health is getting worse. Here is what the forum’s keynote speaker, Shannon Brownlee, had to say:
The County Health Rankings and Roadmap program website, a collaboration between the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation, estimates that clinical care has an overall impact on health outcomes only about 20 percent of the time. Their model shows that social and economic factors such as education, employment and income are responsible for 40 percent of the impact on health; another 30 percent is due to health behaviors such as smoking, diet, exercise and drug and alcohol use; and, 10 percent is due to the physical environment.
As Elizabeth Bradley and Lauren Taylor point out in their recent book, The American Health Care Paradox: Why Spending More is Getting Us Less, the United States, under-invests in ameliorating the social determinants of health. For every dollar spent on health care, only about fifty-five cents is spent on social services. In other developed countries, the ratio is much different: for every dollar spent on health care, TWO dollars are spent on social services. When health care and social service expenditures are added together, the U.S. lags behind many other countries in our total investment in our people’s well-being (see slide 6).
Even within the medical care system, as Brownlee points out in the video clip, we are underusing many services, including mental health care and primary care; as well as that most precious commodity of all–the ability of clinicians to spend time with patients. As she says, “…with one hand, we permit the social and economic conditions that lead to rising rates of chronic illness. With the other, we pour money as fast as we can into a fantastically wasteful, expensive health care system.”
To transform our health care system to one that promotes health, we are going to have to stop overusing services that are unnecessary and even harmful and start investing in the things that actually improve health.