Opinion: Let's make the drivers of health the focus of the HEALTH debate

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By Elena Marks
EHF's president and CEO
 

At the recent Democratic presidential debate in Houston, we heard more details about health care and the candidates' ideas to improve our health care system. It's not surprising considering a plurality of voters see health care as the most important issue facing the nation. But as these issues continue to be discussed, I’m hoping we will also hear about how to actually improve Americans' overall health. It’s not enough to talk about the health care system without a focus on actually improving health.

Despite spending more on health care each year, Americans aren't getting healthier. In fact, the U.S. ranks below other developed nations on measures such as life expectancy, infant mortality, and access to primary care. We know the cycle is unsustainable, yet we fixate on managing the symptoms—health care—instead of focusing on the root causes that can deliver better health. There's good news: a growing body of research shows that by focusing efforts on the non-medical drivers of health, people can get healthier while the health care system saves money. Many chronic health conditions are directly connected to the social, economic, and environmental conditions where a person lives.

Clinical care—arguably one of the largest pieces of health care being discussed on the debate stage thus far—is only 20% of what contributes to a person's health. The remaining 80% is determined by those non-medical social and economic factors like housing, neighborhood safety, family support, access to healthy foods, income, and more. What good does it do to treat people with medical care, if they’re sent right back to the conditions that make them sick?

Take Angel, a 14-year-old Texas teen who loved to play soccer, but suffered from severe, recurring asthma attacks. The key to better health for Angel wasn't a new clinic, more insurance coverage, or the latest medical treatment following his next asthma attack. Instead, it was understanding the conditions that trigger his asthma attacks so they can be prevented in the first place. By replacing carpets, improving ventilation, and removing household mold in his apartment, Angel was able to reduce his asthma attacks. His asthma was managed by a one-time, low-cost, home remediation fix that health insurance and government programs typically don't pay for. 

Better health doesn’t come from home visit programs alone. A Texas study looking at the relationship between county public spending and health found that shifting current funds to public services such as public health, fire and ambulance, housing development, and libraries was associated with improvements in a county's health ranking. After the study was released, several cities and counties across East Texas are now analyzing their own budgets to see if similar spending changes could result in similar health improvements.

It's also encouraging that private insurance companies and government agencies are beginning to recognize the important link between the non-medical factors that determine health, health outcomes, and costs. Recently, the federal Medicaid office approved North Carolina’s $650 million Healthy Opportunities plan to launch pilot projects that address transportation, access to food, and housing. Projects include home remediation programs for asthma patients and meal delivery services for those who are battling diabetes. The plan allows North Carolina to use Medicaid to pay directly for non-medical interventions that target the social determinants of health. Although this and other pilot programs are encouraging, there remains no systematic way to pay for evidence-based solutions targeting the non-medical, primary causes of health challenges. 

Organizations such as ours, the Episcopal Health Foundation in Houston, invest in community-based programs that address the root causes of poor health. The greatest reward is seeing our grantees that work within the health care system deliver improved health outcomes and lower costs with solutions that go beyond the exam room. But a nationwide culture shift calls for leadership from policymakers to shift health care resources to efforts that tackle the underlying, non-medical conditions that cause people to be unhealthy.

As the presidential candidates continue to present their platforms, their health policy debate plays an important role in setting the agenda for the next four years and beyond. Now is the time to change the conversation to improving health, not just health care. That means the discussion must go beyond the cost of care, and instead addressing the root causes of poor health that ultimately will result in a healthier America.

September 2019

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