ORLANDO — The health care industry has long been discussing the importance of prevention, getting upstream and out into the community to stay on top of chronic disease. But those efforts are getting an even bigger boost with the involvement of the nation’s top doctor.
Monday night that doc, Surgeon General Vivek Murthy, M.D., sat down with Don Berwick, M.D., former administrator of the Centers for Medicare & Medicaid Services, for a conversation on population health to help kick off the Institute for Healthcare Improvement’s annual forum. Vivek is relatively new to the job, so he’s spent the last 11 months on a “listening tour,” gathering input and determining his priorities for the position.
Two that have bubbled to the top, Vivek told attendees, are the need to better promote a “culture of prevention” — whether through nutrition counseling, exercise, etc. — along with the importance of addressing equity so that all in this country have access to health care.
Too often, a large portion of a person’s health is decided by factors over which they have no control, he believes.
“The problem is, right now, whether or not people have the chance to succeed is often based on chance,” Vivek said. “It’s based on whether or not you’re lucky enough to live in an area that has the kind of infrastructure for prevention set up, and my hope — and with the work that IHI is doing moves us closer to this dream — is that we will ultimately one day live in a country that has such a strong foundation of prevention that tools for emotional well-being and physical activity are available to everyone.”
But what can the health care field do to help the surgeon general pursue those priorities in the coming years? asked Berwick, who is also a senior fellow with IHI and its former chief executive. The first thing, Vivek believes, is that doctors need to be taught how they can tackle their patients' problems upstream before they snowball into chronic disease. “It’s just not part of our training right now. But I do think that we can help to expand the mindset of our health care providers to recognize that much of what determines health is often driven by the community,” he said.
Secondly, Vivek said, once hospitals have successfully broadened doctors’ views on prevention, they must give them the tools and infrastructure to actually do something about it. He used Mercy Medical Center in Iowa as an example. A few of its doctors were on the board of the local YMCA, which was considering building a new facility, and suggested a collaboration whereby they could refer patients to the nearby Y for exercise and lifestyle changes, similar to how they refer someone for physical therapy. The institution ended up colocating a facility near the hospital, and the two have built a reciprocal relationship.
“If we can do more of that in our country, I think we can not only improve health, but we can create a much more resilient, fulfilled and excited health care workforce than we’ve ever had before,” Vivek said.
Kaiser Permanente is one such health system that’s already taken the surgeon general’s priorities to heart, long before he took over the post. Earlier in the session, Tyler Norris, vice president of the Center for Total Health for the California integrative delivery network, discussed the massive system’s “all in” approach to tackling community well-being. Its efforts have included everything from helping to create jobs in the communities it serves to investing in greener energy sources, and working with local officials to build more walkable streets.
Disappearing are the days when a health system can just discharge patients into a “toxic community” with no place to exercise or buy fresh produce, and expect that they won’t eventually end up in the emergency department again, Norris believes. For Kaiser, taking on these issues goes far beyond feel-good corporate philanthropy for a hospital.
“I think we have a tremendous opportunity in health care to use everything that we have within our own institutions and with our partners, and this is not just corporate social responsibility,” Norris said. “You’ll hear that from the private sector. There’s nothing the matter with corporate social responsibility. This is a deeper practice. This is all-in care.”