Picture a giant circuit board with dozens of crisscrossing components. Each has its own task to perform, but to operate as an effective system, every individual component depends on every other.
Now picture American health care. Until very recently, it was a "system" more in theory than in fact. The dearth of common measures for quality of care and outcomes, the slowness to adopt electronic records that could be shared with a patient and all of her providers wherever and whenever she needs care, and the inability to rapidly disseminate best practices showed how siloed and disconnected the whole enterprise was.
That's changing, as health care organizations recognize that sharing their expertise, data and certain other resources can improve quality and efficiency. And as regulatory and market forces compel them to do so.
But health care isn't just a system in itself. It's part of a community. Like any system, a community operates most effectively when all components work in tandem. That includes everything from education to business to public safety to social services. It certainly includes health care. Common sense tells us that making people well — or keeping them from becoming unwell — depends as much on social, economic and environmental factors as it does on medicine.
Earlier this year, the Commission to Build a Healthier America recommended "a seismic shift in funding priorities to improve health." The commission, convened by the Robert Wood Johnson Foundation, urged leaders across the United States to increase access to childhood development programs, revitalize low-income neighborhoods and broaden the mission of health care providers beyond medical treatment.
"In addition to conventional vital signs such as heart rate, blood pressure and temperature, nonclinical vital signs such as employment, education and housing provide important information about a patient's health," commissioners stated. "Health professionals need training and support to identify the realities in patients' lives that most significantly impact their patients' health."
The results of a North Carolina study, published in March in the journal Science, surprised even experts by vividly showing how important nonmedical factors can be in an individual's long-term health. As reported by Sabrina Tavernise in The New York Times, researchers began in 1972 to follow two groups of babies from poor families. One group received full-time day care up to age 5 that included meals, talking, games and other activities. The other group received only baby formula.
Forty-two years later, as Tavernise notes, "the group that got care was far healthier, with sharply lower rates of high blood pressure and obesity, and higher levels of so-called good cholesterol."
The notion that health care must work with others to address nonmedical factors isn't new. It's been implemented broadly in behavioral health in what has come to be called "wraparound care." And the RWJF commission offers interesting examples from other providers in its report.
The commission's recommendations may seem pie in the sky, given today's fiscal realities. So researchers are studying whether addressing all the issues, medical and nonmedical, that affect an individual's physical well-being is less costly to the nation than the lost productivity and poor outcomes that result from them.
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