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Gross National Health
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
A key challenge of health care reform is that there is significant financial investment in the treatment of disease. The rising disparity between medical cost and quality is demanding that the focus be changed. As America explores new models of delivery, it is important to ask, what is our primary intention? Is it a continued focus downstream on disease management or is it truly health?
America has a profit driven medical system that has disease care as its primary product. Since disease is what brings profit, it directs the energy and talent of the medical system. Currently, disease care guides medical education, hospital growth and drug development, but provides little financial incentive to avoid disease or to achieve health. In fact, if we can help our patients adopt lifestyle behaviors that result in health, profits decline because health is not the product that brings value to the current medical model. Walter Willett, a Harvard nutrition expert reports that 65% of chronic disease could be prevented with improved nutrition. Imagine a health care system that first focuses upstream on creating health for its constituents. Our current medical system does little to honor the term "health care."
Consider the country of Bhutan that has organized their whole government around the intention of creating happiness for its citizens. A New York Times interview quoted Lyonpo Jigmi Thinley, Bhutan's home minister and ex-prime minister as saying, "We have to think of human well-being in broader terms. Material well-being is only one component. That doesn't ensure that you're at peace with your environment and in harmony with each other." When a nation focuses only on growing the monetary value of its output (Gross National Product, GNP), this intention can actually sacrifice the health and well-being of its people. For example, economic activities that are priced equally can differ in their costs to society. Think of a dollar's worth of broccoli and a dollar's worth of a processed pastry rich in trans-fatty acids. Both can have similar economic rewards, but one has health benefits and the other can contribute to disease growth.
Currently America's health care system has a similar concern. Human disease and its treatment is what gets measured, taught, reimbursed and researched. Our "health" care system honors Gross National Disease (GND). Imagine if our political, business and health care leaders could agree that the most important outcome that our nation could invest in were the health of its people. What teams of professionals would need to work together for success? How would we reimburse for health creation? We could answer these questions if our main intention were to create "Gross National Health (GNH)."
To deliver the value of health, we need to create a climate conducive to growing systems of health care. If we can financially incentivize health, talented people will be called to achieve it.
For GNH to be successful, we would first ask what is right with people and help it grow before asking what is wrong with them and try to suppress symptoms with medical technology. When disease care is the product, we often treat dis-ease with drugs. For example, if a patient comes in for upper abdominal pain, the current medical culture supports prescribing a drug that significantly reduces acid in the stomach to improve symptoms. The clinician can do this in 5 minutes which is economically supported by being able to see more patients and encouraging dependence on a product that supports a large industry that puts food on the table for many of its employees (pharmaceutical industry). This focus distracts the clinician from taking the time to listen to the story of the patient to find out about their nutritional habits or what's "eating them up inside." It also increases side effects from long-term acid suppression when acid is needed to absorb iron, calcium and B-vitamins. The end result focuses on symptom suppression, not symptom resolution. Investing in health and disease are both important but are currently out of balance. Ninety-Five percent of our health care dollar is spent diagnosing and treating disease. However, the greatest influence on major diseases is not intervention with medical technology but prevention via human behaviors such as not smoking, improving nutrition, regular exercise and stress reduction. Health is not about what we take, it is about what we do.
What would a health care system that has Gross National Health as its primary intent look like? How could we make delivery of health a viable business? As with many movements, public awareness is shaping government policy. People are realizing that happiness and health do not always come in a pill, but in the form of human relationships, movement, whole food and spiritual meaning. As the public demands access to a health care system that provides proactive health benefits, the demand for fitness trainers, nutritionists, psychologists and spiritual guides will go up while reducing our nation's dependence on ‘happiness in a pill.' Technology and medicines are important ingredients to health. Currently technology has overpowered the importance of the person's story and the opportunity to tell it to a clinician who has time to listen. What if our medical care system helped people come off medicines instead of primarily prescribing them? The irony is that the business of health is currently in stark contrast to the business of disease. This can change if we work together and create a shift to have health as our primary intent.
31 Comments so far
Show All"To deliver the value of health, we need to create a climate conducive to growing systems of health care. If we can financially incentivize health, talented people will be called to achieve it."
Ah, doctor, doctor, doctor... What we need to do is to de-incentivize our current capitalist system of ill-health for all: the advertisements for junk food, the incessant commercials for medications, the glorification of overwork, the absence of messages promoting whole foods, good sleep, and healthy social outlets. Once again, the individual is expected to make all the required changes in lifestyle, while the corporations go on making bucks from the poor health they encourage in so many ways. Nothing will change as long as coke, pepsi, archer-daniels midland, pfizer, blue cross, and all the rest are allowed to hawk their wares and influence policy.
Sioux Rose
DROSERA: Great post. I would add that we are also being passively poisoned through chemical agents in our soil, air, and water; and these factors hold cumulative effects. Nor are the perpetrators generally held to account thanks to a defanged FDA and EPA. Food is often irradiated, or stewed in preservatives, or biogenetically altered without the consumer's knowledge of these "little" items. Thus the challenge of retaining health is made more difficult as a direct result of these practices which allow corporations to retain more of their profits at the public's direct expense.
Yes, today's fully integrated corporations profit when they sell you the poison, profit when they sell you the insurance that promises to pay for treatment for symptoms the poison caused, profit when they sell you the drugs to treat symptoms of the poison, and profit when they foreclose on your house because the insurance they sold you didn't cover all the bills...
And if the corporations' poisons succeed in making you obese, they can also profit from weight loss and obesity treatments.
When everything is about money, all you get is treatment of the symptom at best while the patient keeps having to limp until the disease causes irreversible damage or death to the victim. People think that insurance is their savior but it's not and they never learn until it hits them and then only some bother learning the lessons from their foolish thinking. Meanwhile, those preachers who rant on about "personal responsibility" go out on a limb to make it difficult for people to achieve it. It's even funny but sad how some people trash alternative practitioners as "quacks" but say nothing about bad doctors who get to advertise themselves the most simply because they do the most business with Big Pharma and Insurance. More than a phonebook, Internet is where I have to turn to if I ever had to find an alternative practitioner. I guess some people will do almost anything in their sheer blindness and naivety to defend the privatization of coverage and medicine.
New model of delivery?
It's the same old, same old: insurance companies are in charge of your health care decisions.
The same model is still in place: only much more resistant to actual reform. That new model of delivery would have been single payer. Obama eliminated that pragmatic compromise from his choices before the kabuki theater began.
Obamacare is a corporate welfare program, not a health care reform program.
People know very well that weight control, exercise, a balanced diet, low or no alcohol consumption, adequate rest and low stress contribute greatly to a healthy body. We know this. It is our responsibilty to maintain good health as best we can. We choose instead to be overweight, get little exercise, eat foods which are poor nutritionally or actually harmful, work too hard, sleep too little, and allow life's worries to get us down. We go to a doctor and demand a pill (or more likely an assortment of pills) to make up for the terrible treatment we give our bodies. This is not the fault of the health care system. It is our fault and we will continue to refuse to take responsibility for our own health.
Even people who maintain healthy lifestyles are guaranteed to be free of doctor visits. The health care system is at fault for keep good foods and medicine out of the market as much as possible thanks to putting profits over actual care and the same goes with insurance. You must be so proud to have such an embarrassing health care system in America.
It's the fault of both. It would still be a good thing to have a health system rather than a disease system as we are a society after all.
(BTW, the last time I visited a doctor was in 1972, and that was a requirement for a job. So, I'm saying this from the perspective of someone who has taken care of himself.)
Definitely some pretty good genes, too. Plus, say what you will, a sister who is a deep herbalist.
And plenty of good exercise when I was a kid. This is incredibly important in building health for the rest of the life.
It is disturbing to me to see that this aspect of health is not considered enough. It would be easiest to accomplish by letting kids roam around all over the place, like I did, because it's what they naturally like to do, but social factors prevent it too often.
Agree; but with certain caveats. We choose our lifestyle, but make bad decisions in the process. The root of the bad decisions are lack of education (e.g., from parents, peers and scholastic institutions) and influence of marketing, especially from junk food restaurant companies which promote supersized unhealthy "food". Of course, blaming external forces for the bad decisions doesn't absolve us of all our responsiblity; however, acknowledging that the external forces influence significantly our decision making is acknowledging we are not robots, but imperfect human beings. Another thing this recently passed "health" care bill did not do, which was needed, was implement a vigorous nationwide education program promoting behavior conducive to good health. The program would have taken out junk food vending machines in schools, taught students not only the 4 basic food groups but taught them why junk food is bad for you; put on TV add blitzes educating the public... Lobbyists would have fought that, but so what, because without the education program, we Americans as a whole are consequently paying higher insurance premiums for a riskier (healthwise) lifestyle.
Four basic food groups? I did a Google search and found that the CDC now lists seven basic food groups.
Thanks for the education, I stand corrected. Of course, your comment only proves my point further about education; and I eat well and exercise regularly. :)
http://www.cdc.gov/nutrition/everyone/basics/foodgroups.html
Sioux Rose
KAYAKER: I do not identify with anything you said. Most of my friends are very conscious of staying healthy by getting exercise, eating wisely, using few to no stimulants, and avoiding what stress one can (given the insanity of our nation's direction). This idea of "we" presumes a uniformity that does not exist. I do notice that lower income people sometimes eat a lot of empty calories and as a result, blow up like balloons. It's a sad thing. Often the cheeseburger at the fast food joint is cheaper than decent produce... choice means more when one has the income to allow for more diversity, and the knowledge to really undestand the links between sound nutrition (as opposed to what gets advertised on TV) and optimum well-being. I am over 50, still wear the clothes I wore 25 years ago, get LOTS of exercise, and want to improve my green thumb to grow some salad items. I don't have health insurance and don't intend to pay for it either. (I would pay my share into a single payer system if the entire system was totally reformed to allow for more natural treatment options, and less of the "one size fits all" model that makes for more efficient profits.)
"How could we make delivery of health a viable business?"
That's the problem, isn't it? Like almost everything else in the U.S., the health and general wellbeing of its citizenry must fit the business model of its so-called "free enterprise capitalism."
You might as well ask how to make all other common protective services (police, fire, etc.) viable businesses. Fire departments used to be. Why not just go back completely to "rugged individualism" and "every man for himself"? Those were really the good old days.
"What if our medical care system helped people come off medicines instead of primarily prescribing them?"
Trouble is, there is no "influence" (money) among those who would lobby for that. Whereas Big Pharma, etc.... The system is corrupt beyond measure and there needs to be a systemic change.
Not exactly...
"What if our medical care system helped people come off medicines instead of primarily prescribing them?"
Perhaps, if this issue really matters to you, it would be well to consider talking about health care in the context, not of medicine and medical practitioners, but of physicians and health care practitioners, recognizing that there are multiple kinds of physicians, not just medical ones.
The fact is that we have a medical system in place in the USA. The word 'medicine' means treating disease by the use of medicine. Medical doctors, MDs, prescribe medicine, that's what they do. There are many other kinds of physicians in the world, such as chiropractic, homeopathic, naturopathic and osteopathic but being a medical doctor means a doctor of medicine. MDs have ostracized other forms of physicians, and only in the past 50 or so years have osteopaths been found acceptable. It may be time to carefully distinguish these terms and concepts so as not to conflate medical care with health care.
PROMISED Single-payer.
We didn't get healthcare but only the onus to pay corportate tribute - at the point of a gun. A pox on both parties!
The people with the money make the rules. That is why we see constant ads everywhere about how all of the new magic pills will fix all of our problems and do it so easily. Big Pharma and the insurance giants are benefiting greatly by all of our diseases and self made problems. The tobacco companies did the same thing with advertising until stopped, and only the power of the federal government could do that.
Most people realize the advantages of ending up in Heaven, but many do not want to do what is necessary to arrive there. It is the same with health, most know what they should do to have it, but cannot seem to live in such a way as to obtain it. Again, constant advertising controls people`s desires against their best interests.
Here is a start to wellness.
Ban all television advertising from 6 am to 9 pm each day.
No, I do NOT think advertising is a freedom of speech issue but if people insist that it is.
Allow all advertising on ONE channel only.
I just finished watching "Sicko" from the ironic MM and I was thinking about socialized medicine in conjunction with single payer. See, people talk all about coverage but it is an irony that even progressives and liberals fail to realize that socialized medicine like what the British have is actually what helped the single payer system withstand hooligans like Thatcher. Conservatives always preach personal responsibility but it has to be made obvious that socialized medicine in conjuction with single payer would actually enforce personal responsibility in the long run.
P.S.: Thanks Naturally for earlier referring to that film. One of my neighbors, an MM fan, had that DVD with her.
Ninety-five percent of the health care [HC] dollar is not spent on diagnosis and treatment. How many ads are seen on TV for medicines. The cost of health care is much more complex.
It seems to me that the fundamental problem is regarding HC as a business needing profit as the motive. Also, although this country has inordinate resources they are squandered on things that well may harm health in a number of ways - wars, planned obsolescence, refusal to evolve where energy is involved, to name a few. Where the gap between personal wealth
and poverty widens longevity is decreased. Until a way is found to meaningfully evolve using science, technology and respect for each other, a healthy, happy life is hard to achieve. The future is coming whether we plan for it or not.
Freeze - it's the Happiness Police!!
I would call this Hedonistic Health Care. In 1929 Bertrand Russell wrote a book suggesting the folly of using "happiness" as a critical metric of the optimal, to-be-desired state of humankind. In a different way, so did George Orwell in his work, "1984", which has a Ministry of Truth posting idiotic shibboleths on buildings and blaring blatant lies from omnipresent loudspeakers.
Today, when out in public, it is important LOOK HAPPY because any other demeanor might get one Tasered by the squeaky people.
To take this World Health concept seriously requires such a degree of forced optimism that one suspects a complete absence of understanding of what is really going on in the world.
Do what you want, but when the siren sounds I'm not walking ataxically towards the Gathering Place with my arms stretched out in front of me and my eyes in a thousand yard state. Report this comment.
Trylon
I, and many other people never made any kind of "life-style choice" to be over worked or to live in a polluted environment: these things were imposed upon us by force. I don't eat junk food or have a beer belly, nor do I smoke. Funny, I still live in an environment that shortens my life expectancy. Those of you above who mentioned the pollution and the stress as affecting our health: thank you.