The query gripping the nation: "How do we reform health care?"
But I don't hear anyone asking a far more essential question: "What is health?"
Given that we all want health and spend trillions to "care" for it, it's sobering how little thought we give to its true meaning. When I ask, the response I receive is typically "the absence of disease." Health is much more interesting and consequential than this. To define it in this negative sense is no more accurate than to define wealth as the absence of poverty.
I define health as a positive state of wholeness and balance in which an organism functions efficiently and interacts smoothly with its environment. Good health comes from an innate resilience that allows you to move through life without suffering harm from toxins, germs, allergens and changing environmental and dietary conditions.
By no stretch of the imagination does mainstream American "health care" move us closer to this vision of robust, resilient health. It is a fiscally unsustainable, technology-centric, symptom-focused disease-management system. Consider that two-thirds of all Americans die from cardiovascular disease, cancer, and diabetes, which are all strongly associated with lifestyle choices. Maintaining and paying for our current system will serve only to continue - if not exacerbate - this trend, and bankrupt the nation in the process.
A truly reformed health care system will care for our health rather than care for our ills. This does not mean it will abandon those who are sick or injured. Instead, measures that maximize our innate self-healing capacity - our health - will be used first whenever possible to both facilitate recovery and keep us whole and balanced.
How do we get there? Here is a summary of the health-promoting, disease-preventing agenda that I set forth in my new book, Why Our Health Matters: A Vision of Medicine That Can Transform Our Future available September 8, 2009.
- Our medical schools must teach health promotion along with disease management and crisis intervention. If the National Board of Medical Examiners included questions on these subjects in required student exams, schools would quickly add them to their curricula.
- Insurance companies, whether private or government owned, must be compelled to pay for health-promoting measures. In turn, this will encourage physicians to offer such treatments in earnest.
- The federal government must create new departments within the National Institutes of Health and the Department of Health and Human Services to emphasize health promotion and disease prevention. An Office of Health Education should be set up within the Department of Education to establish a K-12 curriculum of health, healing and disease prevention.
- Citizens must pressure the American Hospital Association, the American Public Health Association, the Centers for Disease Control and other relevant governmental agencies to make greening our hospitals and medical centers a top priority so that they themselves don't create even more illness. Examples of such changes: stopping environmental pollution caused by hospitals (e.g. mercury discharge) and banning the sale of junk food on their premises.
- We need to accept the seemingly obvious fact that a toxic environment can make people sick and that no amount of medical intervention can protect us. The health care community must become a powerful political lobby for environmental policy and legislation.
- We need to support grassroots movements to ban sales of soft drinks and junk foods in public schools, make schools serious about physical education and health education, and fight attempts by agribusiness to weaken federal organic standards.
- We must insist (with the power of our pocketbooks, voices and written words) that television networks, movie studios, radio, the internet and print use their tremendous influence in a positive way. The media showers us with destructive, illness-promoting messages (such as kids devouring junk food and adults popping pills for trivial, transient discomforts) and fear-based news reporting on health. We must use creative messages in the media to counteract this influence.
- American businesses are struggling to pay outrageous, exploitive insurance bills for their employees, hampering our ability to compete globally. In 2005, General Motors paid an estimated $1,525 in health-care costs for each car it made; Japan's Honda paid $97. We must convince corporate America that preventable employee absenteeism and diminished productivity can be counteracted in a cost-effective way by offering workers health-promoting programs such as discounted gym memberships, smoking cessation programs, and more nutritious cafeteria food. Ultimately, the sophisticated American marketing talent that pushed us toward unhealthy behaviors might be marshaled to move us all in directions that are more consistent with good health.
Benjamin Franklin's adage "An ounce of prevention is worth a pound of cure" has never been more relevant. In Franklin's time, contagious disease was the scourge of humankind, but focused effort has rendered it a historic footnote. With sufficient will, we can do the same with chronic disease that now costs us so much to manage.
Relman, Arnold S., M.D. A Second Opinion: Rescuing America's Health Care. Public Affairs, 2007, p. 78