As a medical student, I have learned much about treating illness, but how much does health care really have to do with health? As it turns out, not much. Health care contributes only 10-15 percent to a person’s overall health. Income level, access to higher education, where we live, whom we live with, our genetic make-up, job stress—factors such as these contribute the rest.
Since the famous “Whitehall study” in Britain revealed a link between work environment and health, researchers have continued to accumulate evidence on how life circumstances affect our well-being. A recent study in the American Journal of Public Health found, for example, that roughly 250,000 deaths a year can be attributed to the effects of not obtaining a high school diploma. That’s 50,000 more than the number who die each year from a heart attack—the leading medical cause of death in America.
There is broad agreement that medical care in America is too expensive. Medical bills are the cause for approximately 60% of all personal bankruptcy fillings. Health expenditures account for almost a fifth of our country’s Gross Domestic Product. Certainly we must reduce unnecessary health care spending, eliminate waste and fraud, and streamline medical care, all while improving quality. But maybe we should also try to prevent some of these costs from occurring. Maybe policymakers should redefine how they attempt to "bend the cost curve.”
If social factors affect over 80% of a person’s health, shouldn’t this be at the top of our conversations about how to achieve savings?
Doctors are waking up to the idea that education and social policy is our health policy, and policymakers should too. As Dr. Steven Woolf writes in the Journal of the American Medical Association, “The biggest threat to public health may come from funding cuts outside the health sector. Namely, budget decisions that affect basic living conditions – removing opportunities for education, employment, food security, and stable neighborhoods – could arguably have greater disease significance than disruptions in health care.”
Today, the sequester puts access to many social programs at risk. The Department of Housing and Urban Development estimates that 125,000 individuals and families could become homeless due to budget cuts. Hundreds of thousands of low-income families may lose access to WIC, a highly successful program that provides supplemental food and education to pregnant and breastfeeding women, as well as vital nutritional support to infants and children.
Many argue that we do not put enough emphasis on personal responsibility when it comes to health. In some ways, they are right. The foods we eat, the risks we take—these play a big role in health outcomes. But there are other things we cannot control. We do not choose to be born into a low-income family. We do not choose to lack access to nutritional food or be homeless as a child. We do not choose our genes. All of these factors play a larger role in our health than is commonly understood.
As a physician in training, I have learned much about the importance of “preventive medicine” – the concept that doctors should prioritize preventing disease instead of simply reacting to it acutely. This approach significantly enhances the quality of our health care dollars spent. The cost of a flu vaccine is trivial compared to the financial and emotional cost of a hospital stay for complications due to influenza.
North Carolina lawmakers should use this same preventive approach when addressing health care costs. They should focus on programs that reduce social disparities, promoting a healthier population that will have less need for avoidable medical care. Broad cuts to social programs only ensure higher costs down the line.
Time magazine recently featured Steven Brill’s stunning expose on the true cost of health care in America. While controversial in some respects, one cannot argue with the raw data: “We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy. We spent almost that much last week on health care.”
Clearly it is time to give our state’s health care policy a dose of preventive medicine.
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