All of us have heard complaints about the increasing costs of healthcare. The out of pocket expenses for most consumers of health care have risen and the expenses have climbed for employers and public agencies as well. Statistics show our nation’s health expenditures are on such a breathtakingly unsustainable trajectory that one day in the next few decades costs will exceed our GDP. The causes are multifactorial, but a large component is the continuing decline in overall health due to poor lifestyle habits or choices.
Emphasis on the social determinants of our declining health have gained attention lately. The idea that there is much more involved in a healthy population than simply changing things in the doctor’s office--like how many same day appointments an office has, how many visits per year a diabetic has, or what time the appointments are available for sick children--has started to come into focus. These health determinants are also bigger than issues like what children are eating in school or the availability of fresh produce. While focusing on these smaller issues is important, each results in just a small amount of improvement (ex. in the case of healthier school lunches, the projection is that it’s implementation costs more than it saves in health benefits). Even better chronic disease management, again very important to overall health and something being pushed quite extensively right now, may not be the savings slam dunk we have been sold.
Ideal Medical Practices docs recognize the importance of a grassroots effort. We work with our patients to provide them with the best care based on their position and circumstances. We are in the perfect situation to focus on grassroots for improving the social and behavioral health pathways of our communities. There needs to be a shift at the level of the community or “social norms.” Smoking is a good example of an evolving social norm in the U.S. As we learned more about the harm it does and society’s position on smoking changed, there is an increased social pressure (really stigma) to avoid smoking. As primary care providers, we can help by following good health habits ourselves. We don’t have to be perfect, we just need to be on the right path. Let’s make it clear that being overweight and underactive is bad for our health. We suffer from the same pressures as our patients: too much work, not enough time to make healthy meals, not enough exercise, not enough sleep and so on. We should work on solving those problems in our lives and share our insights. We should be able to outline for patients what constitutes an adequate amount of physical activity, an appropriate diet, a good way to manage stress etc. I bet we all have patients in our practices that have really turned their health around. We should look for these people among our patients, friends, families and neighbors and call on these “health ambassadors” to help spread their good habits in their circles. What we will find is that as they encourage others, they are more likely to maintain their own health, and begin to change the social norms of the practice. And as those change, hopefully, we can finally begin to get a grip on the devastating health care costs haunting this country.