Diseases have changed. Why hasn’t our mindset?
We still behave as though our primary killers are communicable diseases.
Ebola, one of the deadliest infectious diseases, set the world on fire recently. It killed 11,315 people – almost none in the rich world.
Contrast that with heart disease that kills 610,000 people just in the U.S.
Like Steven Soderbergh depicted in the movie Contagion, may be there’s always a risk of viruses killing whole populations. Not so likely. But may be.
The real risk we face is through self-created, longterm conditions. That take time to develop. Take time to kill. Take time to respond to care.
In dealing with viruses, we expect to be inoculated from the diseases they bring. A booster shot to make us immune from say, smallpox.
It’s kind of a quick-fix. If you can find the cure, the disease goes away. But chronic conditions don’t respond to quick fixes. It’s not like if I pop a pill, my hypertension goes away. It stays may be until my lifestyle stays.
As patients, we prefer quick fixes. Take a pill for diabetes. Get back to our lifestyle of gorging and binge drinking.
As health systems, we are all too excited to provide quick fixes. Prescriptions. Angioplasties. Replacement surgeries. The healthcare world revolves around fixing problems.
Our killer diseases have changed. But approach hasn’t.
It’s changing. Our environment.
It shouldn’t be surprising to anyone to note that our environment has changed in the last 20+ years. It’s common to see more obesity around us. Young people are getting sicker sooner – from metabolic disorders to cancers. Chronic conditions, such as hypertension or diabetes seem to have become an accepted norm once people are in their mid 30s. We are staying alive longer, not necessarily healthier.
It’s just not rich countries, such as the US but nearly every developed pocket in every part of the world is going through environment changes. Lifestyles are more similar than dissimilar. From Lima to Mumbai to Detroit. Diseases are more common than not.
Despite its obviously close link to non-communicable diseases, the environment has almost no role to play in our healthcare systems. We don’t bother about identifying and addressing the causes of stress, or developing an understanding of the patient’s home environment. It’s non-clinical and therefore non-pertinent in today’s medical world.
Time for redoing healthcare
Across the world, we adopt a wait-and-watch strategy. We wait for the patient to fall sick and then fix him. We know how to perform procedures well, even complicated ones. But we simply aren’t structured to keep people healthy.
The loss of focusing only on sickness is enormous. Financially. Emotionally. At an individual level. At a national level.
Healthcare occupies increasing proportions of every country’s GDP. Economies may be slowing down but not their healthcare burden.
You may think that this must be good business for healthcare. Everyone gets to keep drinking the Kool-Aid. There’s problem with that thinking.
We are in a healthcare party bus that’s already taken a wrong turn. And we’ve forgotten where the breaks are.
Trust amongst patients and doctors is declining. Demand for healthcare is enormous but supply is short. Yet, most hospitals and clinics struggle to turn a profit. Our financial incentives are built to drive more transactions, not solutions.
Thinking of ‘health’ as a currency
In business, Profitability = Revenues minus Costs.
In healthcare, Health = Well-being minus Diseases. If ‘health’ were a currency that we want more of, we would deal with two main levers.
1) Improve well-being
2) Reduce disease
Healthcare industry in its present state focuses on #2. But our new killers, chronic conditions, are closely related to #1 – improving well-being. The healthier we are, the less likely that we get them. But as an industry, we aren’t as interested in #1.
If we must rethink how we do healthcare, health systems need to expand their scope far beyond their doors. Financial incentives must be structured to consider the entire equation – both #2 and #1.
Until then, we can only hope that the healthcare party bus doesn’t fall off a cliff. Amen.
Stay in touch at redo/healthcare.
Question: Did I just talk about some happy Kumbaya? Or, do you think we can really think differently about healthcare?
Image: Patients waiting at Emergency at Adolfo Guevara Velasco National Hospital in Cusco, Peru – watching Pirates of the Caribbean on TV