Americans spend more on health care than any other country in the world, yet all that spending does not translate into long, healthy lives. Not even close. Despite spending $2.87 trillion a year on health care, Americans die earlier than the people of 36 other countries. And even within the United States, there are significant differences state by state, even county by county, drawn along cultural, racial and economic lines.
Why? The answer is simple: health care is not the only thing determining our health. It’s not even the most important thing. In fact, when you look at all the factors that determine how well and how long we live, health care itself ranks quite low on the list. These factors collectively are called the social determinants of health, and they emphasize why we must look beyond health care treatment if we want to truly improve the health of the nation.
In many cases our own behaviors – led by the decisions people make about smoking, exercise and diet — have a greater impact on life expectancy than the care a person gets in a doctor’s office or hospital. Alcohol and drug use and even driving habits also have a significant impact on health and lifespan. Studies estimate that behavioral causes are accountable for about 40 percent of the years lost to premature death.
A person’s genetic makeup accounts for about 30 percent of their overall health. Economic status, race and ethnicity, crime, and access to fresh food as well as safe streets to walk and exercise influence as much as 15 percent of individual’s health and longevity.
It’s estimated that direct patient services impact only about 10 percent of the years we lose to premature death. The only determinant with less impact than health care is environmental exposures to pollution and other toxins, which account for 5 percent of the influences on overall health.
Moving beyond the doctor’s office
Our nation’s growing focus on the health of our population is critical and timely. The rate of early death is dropping in many areas of the country, but too many people in poverty-stricken areas still die young. The number of children living in poverty continues to rise and people are spending more of their income on health care than ever before.
Dollars and Sense
Unstainable health care costs and poor health outcomes should not be acceptable. Everyone with a stake in the country’s health – hospitals, doctors, policymakers, employers, communities and consumers themselves – must think and act more broadly.
Consider the costs we pay for medical treatments today. On average the U.S. spends $73,000 per patient for coronary artery bypass surgery to clear arteries, often clogged by years of poor diet and too little exercise. A new class of cholesterol drugs is expected later this year with an annual price tag speculated to be up to $10,000 per patient.
The newest blockbuster drugs, the high-tech capabilities of our hospitals, precision medicine and other clinical advances will always play critical roles in the health of society. But they are not enough to solve the problem. We have an enormous opportunity – and obligation — to look beyond medical treatment as the only way to improve health. We must do more to address the other 90 percent of factors that affect health and longevity.
What if we directed the same energy, research, pilot programs and money dedicated to health care into addressing the spectrum of these social determinants? Could investments in outreach programs, activities, training and treatments help people reduce the stressors in their lives, before they are fighting full-fledged depression or alcohol and drug dependence, and the resulting medical problems? Shouldn’t we be able to identify and more effectively address disparities in health care?
No one magic bullet will improve the nation’s health. The factors that influence people’s decisions – and ultimately their health — are a complex tapestry of socioeconomic, cultural, and geographic influences mixed with mental health, wellness and access to quality health care. But we can’t let the complexity prevent us from trying to make a difference one person, one family and one community at a time. It starts with accepting that health is bigger than health care.