by Brian C. Castrucci
Health care in America is designed to manage the consequences rather than the causes of disease. It has created expensive solutions for those who are already sick. Nearly all of our health care spending ($3 trillion spent in 2014 in the United States) goes to direct medical care for genetic and medical issues.
However, 70 percent of what makes us sick — the cause of our health care problems — can be attributed to the influence of social, physical, and economic environments on health behaviors. This includes where you live, whether you have a job, whether you have access to fresh fruits and vegetables, how much money you make, issues of race/ethnicity, stress, and more.
Our consequences-based approach to health care will lead to a lifetime of medication, countless doctor visits, and the need for surgery and other costly interventions for those who are chronically ill. It has created communities where there is better access to MRIs than fresh fruits and vegetables and more urgent care facilities than places for free or low-cost physical activity, like parks and recreation centers. The United States spends more than any other country on treating sick patients, but when it comes to spending on the social services that would address the actual causes of disease, the United States ranks dead last. Why are we choosing to wait until people are sick? Why are we not tackling disease at its source? We need to focus on the causes of disease; we need to prioritize prevention.
The Advisory Board Company, the de Beaumont Foundation, the Kresge Foundation, and the Robert Wood Johnson Foundation partnered to launch the BUILD Health Challenge — an acronym for BOLD, UPSTREAM, INTEGRATED, LOCAL, and DATA-DRIVEN — to catalyze a fundamental change in how we identify and address the root causes of long term disease and early death.
The change we need will be BOLD and INNOVATIVE — we need to transform our medicalized culture, where everything is viewed as a condition or disease that can be addressed with the newest pill or medical treatment. Instead, we must learn to focus on the causes of disease, many of which are social and environmental — often referred to as the “UPSTREAM“ causes of disease. It will start at the LOCAL level, where action and change have the greatest chance of success, and it will leverage the incredible increase in the availability of electronic DATA — health data and other sources — to target resources effectively and measure impact.
Hospitals, community leaders, and local health departments each bring unique but complementary resources, perspectives, and expertise to the collaboration. Hospitals and health systems can contribute not only financial resources but also their expertise, other existing resources, and health data that can shape interventions that extend beyond the hospital to the community. Local health departments are trained to identify public health concerns, intervene with evidence-based practices, and often are able to change regulations or policies that can help improve a community’s health. Nonprofit community-based organizations often have the best understanding of the challenges, priorities, and goals of affected communities as well as the solutions most likely to be embraced and sustained.
Each will need to re-imagine their individual missions, how they share data and resources, and how they partner in new and creative ways to improve community health.
The BUILD Health Challenge will identify promising partnerships and projects, nurture them with intensive expert assistance, and begin to identify the necessary pathways to mediate the root causes of disease and improve health outcomes. It creates an opportunity to test new models grounded in creative, collaborative thinking about what can be done in communities to improve health. These projects won’t have to focus specifically on health care, but they will need to tackle broad, systems-level issues like education, access to fresh food, and improving early childhood.
In the United States, we have made a long-term commitment of time and resources to managing the consequences of disease with no real plan to address the actual causes. As a result, we find ourselves in an unending cycle where our best technological, educational, and pharmacological innovations and advances are used to manage new consequences.
The BUILD Health Challenge is a step forward in breaking this cycle. It is an important part of a broader movement that seeks to reset a health care paradigm that has evolved over centuries. If we succeed, we will change from a nation obsessed with health care and managing the consequences of disease to one obsessed with tackling the real causes of disease leading to improvements in population and community health.
This post originally appeared in the Huffington Post on Dec. 5, 2014, and was updated Dec. 6, 2017.