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Persistent health inequalities, a low return on investment on health care spending, and the fragility of our country’s health infrastructure have been compounded by the COVID-19 pandemic. COVID has had an impact on all of us, but especially on people of color and people with obesity and comorbidities.
At the same time, demands for racial justice highlighted health inequalities and the ways in which our health system is not fair. Financial barriers to care, rising insurance premiums, high deductibles and co-payments all contribute to lower access and result in avoiding or delaying benefits for health problems that only worsen if left untreated.
Although Americans spend nearly 18 percent of our GDP on health care, they have poorer health outcomes when compared to other countries. As a country, our disproportionate spending on the delivery of health services rather than larger investments in addressing social determinants of health is a serious misalignment of national priorities.
We pay too much attention to treating disease, not promoting health. We need to rethink our understanding of health and commit to a more holistic and equitable approach to health and wellbeing. We must commit to shift our focus from disease management to health creation, including understanding health inequalities and how social determinants of health contribute to poorer health outcomes for many communities.
This includes the understanding that health is more than just the absence of illness or ailment. Health embodies the various ways in which an individual can live well despite illness and feel good regardless of their living conditions. Health encompasses physical, mental and social wellbeing.
Unfortunately, as life expectancy is longer and a significant proportion of Americans struggle with two or more chronic health problems, the notion of health as more than just the absence of disease is out of reach for many.
In fact, many Americans live in a state of unhealthy.
There is a close relationship between behavior and health and the impact of lifestyle choices and habits on our wellbeing and the risk of disease. Boredom, fear and conflict negatively affect our state of health and wellbeing, while healthy behaviors such as consuming natural whole foods, avoiding tobacco consumption, exercising our body, good sleep, stress relief and resilience are all changeable and established behaviors that lead to contribute to good health.
These types of healthy behaviors should be emphasized, funded, and supported in health education by policies that make healthy choices easy and accessible to all.
Healthcare influencers, advocates, and policymakers in our country have an opportunity to redefine our approach to healthcare with a primary focus on creating health. Health creation requires rethinking from health professionals, patients and policy makers. In order to do justice to the economic and public health system of a sick health system, cross-sectoral cooperation and prioritization of the social determinants of health (SDoH) is necessary.
As Congress is considering laws that recognize and codify SDoH as the primary drivers of health outcomes, policy makers should consider the following recommendations to better align themselves with health creation:
Reconsider healthcare priorities by allocating greater public health resources to support health promotion, especially in colored communities. Tackling racism in the health sector – particularly in relation to the health and wellbeing of the black community – is vital. We need to build trust, understand the values, experiences and beliefs of people of color, and recognize how systemic prejudices and social (disadvantage) benefits influence the social determinants of health for different communities.
Revise healthcare communications and marketing Promote public health messages that emphasize self-determination, resilience and wellbeing of patients regardless of health status or illness. We should also highlight exercise, healthy eating, proper sleep habits, and managing stress as the foundation of good health, while employing a broader health care strategy.
Realign health systems to prioritize health creation and use quality of life and wellbeing results to measure system performance. Providers who offer health coaching and lifestyle advice should receive reimbursements. Incentives should be created for coordination of care and cross-sectoral engagement in order to reduce health inequalities.
Focusing resources on health promotion, emphasizing the fundamentals of health promotion, and improving collaboration can improve public health and better serve the needs of communities that may previously have been disenfranchised by the health system.
To do this, however, we need a paradigm shift away from disease care and towards health creation. While much effort is being made to reform what is often referred to as the “broken†health system, we also need to focus on how we can also create health.
Michele Maiers (DC, MPH, PhD), Executive Director, Research and Innovation, Northwestern Health Sciences University.
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