Curing our ‘sick care’ system
Medical breakthroughs seem to occur all of the time, as new drugs are approved to treat cancer, lower cholesterol and keep a diabetes patient’s blood sugar in check. However, with all this innovation, have we forgotten the importance of preventing these conditions in the first place?
“We don’t have health care; we have sick care,” said Mark Benden, PhD, CPE, associate professor in the Department of Environmental and Occupational Health at the Texas A&M School of Public Health. “The system, as it currently stands, steps in after someone has reached a diagnostic pinnacle of illness, but that’s only reactive, and to me, that’s a failure state.”
The United States government’s public health and preventive spending was $76.2 billion in 2009, which seems like a lot until you consider that it is only 3.1 percent of the nation’s total health care expenditures of $2.5 trillion. By 2015, the total spending had risen to $3.2 trillion, but there is no indication that the percentage of preventive funding was any higher than it was eight years ago.
“We’re great at looking at a car with a blown tire and saying, ‘yes, that is a problem,’” Benden said. “Of course, by that point, you not only need new tires but possibly a whole new car as well, while the accident could have been avoided if someone had noticed that the tire was getting worn and stepped in to fix it earlier.” He sees the American health care system as functioning in a similar way. “We wait for the crash, but if we monitored and intervened early, we could fix before the crisis.” Although that monitoring may be aided by new technology, there is still an important role for the human-to-human interaction and intervention.
“In addition to promoting preventive health behaviors, health care teams need to keep an eye on the person’s trends over time and step in when the numbers start to indicate a problem,” Benden said. For example, providers could monitor someone’s cholesterol levels every year, and if they begin to go up, work with the person to develop a diet and exercise plan to keep those levels from going up further—and potentially leading to cardiac issues.
Benden has another metaphor to explain our current system of prizing the grand cure over simple preventive measures. “It’s not terribly exciting to be the person who created a smoke detector battery that will never go bad…but the fireman who ran into a burning building? Hero,” he said. “Still, if the smoke detector had been working, there would be no need for that heroic rescue in the first place.”
Basic public health measures are like the smoke detector: eating healthy foods, being active and not smoking are all simple, relatively low-cost ways of preventing a great deal of chronic illness. However, because they’re so basic, they are often overlooked, as are the group who does manage to practice them. “The people who avoid a problem are a very important demographic, but they are often ignored,” Benden said. “Still, if we could focus on them and celebrate and learn from their success in staying healthy, we might be able to help others prevent chronic illness as well.”