All too often the feeling is the opposite; it is illness that is everywhere, not health. With the U.S. population experiencing a continuing surge of chronic illness, costing this country, we Americans, 80% of the money we spend on health, why should we think that illness is not here to stay. Sadly, the U.S. is not leading the international change in maintaining and sustaining maximum health for a citizen population. The present generation of U.S. children could be the first to have a lower health and life expectancy than their parents’. Forty-six-plus million individuals in this country live without health insurance and that number will only grow as the economy suffers.
“Sick around the World,” a Public Broadcasting Station (PBS) documentary, reviewed the stark comparisons between the health care systems of these countries to that of the U.S. The one interesting question asked of the health care leaders of the five countries was: “Would a citizen of your country ever go bankrupt over a hospital bill?” The response was “not possible” or “never,” along with a facial expression of surprise and wonder. When the small country of Taiwan, had the opportunity to re-invent their health care system in the 80s they identified those countries considered to have the best systems. When asked, and again with a polite pause in the conversation, the Taiwan spokesperson responded that the U.S. was not one of those countries.
These countries certainly have issues and obstacles in providing the very best health care. However, “health” is considered a human right and thus they are committed, through political will and leadership, in making it work.
Ilona Kickbusch, a well-known health care specialist, who has worked and lectured on both sides of the Atlantic, speaks of the roles of hospitals in the “health society of the 21st century.” At the 2007 World Health Organization-Health Promoting Hospital Network (WHO-HPH) meeting in Vienna, Austria, she eloquently and simply stated that “health is everywhere.” And in that environment she describes the important role of hospitals in identifying and utilizing “health.” Health care professionals from around the world gathered at the annual event to discuss how hospitals can identify themselves as public health advocates for their patients, hospital staff, community and environment. David Ollier of Hospitals and Health Networks wrote of the minimal participation by the U.S. in the international organization in his 2007 article, entitled “American Exceptionalism,” where he comments on “where one is a lonely number.”
The WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity.” In the U.S. we cure diseases and treat illnesses but we are less proficient in the area of hospital based disease prevention, health promotion or public health or public health advocacy.
So, what can U.S. hospitals and health care systems do to realize and benefit from the fact that health care can also be everywhere? First, there is the issue of leadership. We need a different type of health care leader. Hospital CEO’s, Presidents, Trustees should have training, experience, background and appreciation of the broad social and health issues of our day, as well as manage the day to day operations of the health care system. These new health care leaders must find that common ground of how hospitals can obtain the optimal profit margin as well as strategically and scientifically serve as public health advocates for the communities they serve. Second, the international arena is the classroom where we can learn. If we have the desire, fortitude and leadership to redesign our U.S. health care system our hospitals, managed care organizations and political leaders must make the effort to identify this new health care leadership as well as reach out internationally for this level of expertise. The WHO-HPH network would serve as a viable resource.
According to Ilona Kickbush, hospitals must begin to live in the four domains of health – medical health, personal health, public health and the health market. In the health market alone, she describes 18 categories of potential activity. To participate and excel in these activities a new kind of political and health leadership must rise up and be able to speak beyond the important but limited topics of “access to care”, “health insurance for all”, or “reimbursement for clinical services.” For the U.S., we need to strategically create the balance between the attention and funding we provide for treatment of chronic illness and technology and the more encompassing “health society” of health promotion, wellness and disease prevention. As steam was an economic driver in the 1800s, steel in the 1850s, electricity in the early 1900s, the automobile in the 30s and information technology in 2000, health must become the driver in the decades to come. Kickbush and others have commented on these comparisons, with wellness, health promotion and medical technology as being the economic driver for 2050.
And lastly, we must also be willing to retrain our health care professionals. Though we may need more nurses at the bedside of our hospitalized citizens we also need nurses, as well as physicians, who are trained to “clinically” promote the health of the patient beyond that of the hospital bed and back to their homes and work places. Europe, Asia and many other countries are forging ahead on these health care practices. We must work to change how we do health in America.
It is time we counter the impression and opinions of others by reflecting upon a quote from Winston Churchill: “Americans are a wonderful people in that they always find the right answer…after they have tried every wrong answer first.” We can do better, we must do better, and we must find the right answer to better health.
*This commentary was published in the December 2008 issue of Western Pennsylvania Hospital News and More.