GlassHospital

Demystifying Medicine One Week at a Time

Tag: #SDoH

Health is More than Health Care

When we think about achieving good health, it’s natural to think of visits to the doctor for “checkups” and age-appropriate interventions like vaccinations or cancer screening.

But here’s something you might not know: The “health care system” as we know it, an American industry on which we collectively spend $3 trillion annually, only accounts for one-fifth of our overall health.

Twenty percent? How can so much spending impact so relatively little of our well-being?

 

Well, it turns out other factors collectively have a much greater impact:

 

Genetics: To whom we are born impacts our health profoundly. If our parents are blessed with long, healthy lives, then we are much more likely to be, too.

 

Education: The better our education, individually and collectively, the more we can achieve in life. Education is tied to income (something we all know), but it also correlates directly to health outcomes in aggregate. Cutting investments in common and higher education is sabotaging our children’s future — not just in earning potential, but in real health: more suffering and earlier death.

 

Employment: The ability to earn a living wage means that people can be financially solvent and participate in the consumer economy. Given a choice, almost no one would choose handouts. People want meaningful work — work that employs our skills and engages our minds.

 

A diverse economy that grows new businesses means more job opportunities that not only pay the bills but allow us to invest in our families, homes, and communities.

 

Environment: It’s well known that those residing in certain Tulsa ZIP codes have life spans on average 11 years less than those in more affluent parts of the city (This difference has actually lessened from 14 years over the last decade.) Mayor G.T. Bynum has made reducing this disparity one of his administration’s central goals, as celebrated in a recent editorial in this newspaper.

 

We also know that when our neighborhoods are safer, we increase the likelihood that we will move our bodies more — which along with nutrition is the single greatest predictor of good health.

 

And of course: Nutrition! Access to healthy food and safe water is something that most of us take for granted. But many areas north, east and west of downtown Tulsa are literal food deserts — places with greater than two-mile gaps between locations where fresh fruits and vegetables can be purchased. And our Tulsa public transportation options barely ease this burden.

 

Nutrition and exercise are the two health determinants over which we have the most direct individual control. (How are you doing with those New Year’s resolutions so far?)

 

We can’t choose our parents, or therefore our genetics. But collectively, if we are in agreement that we want Tulsa to be a place of improving health, we do have a lot of say in how we manage our neighborhoods, our food supplies and our educational attainment.

 

At the University of Oklahoma-University of Tulsa School of Community Medicine the curriculum emphasizes study and advocacy of these so-called social determinants of health — beyond the “traditional” organ-based pathologies. We believe that interdisciplinary understanding of these factors — which can lead to exorbitant stress — will help to reduce the burden of ill health in our population as we age.

 

Tulsa has an opportunity to become a “Blue Zones” city like Shawnee and Fort Worth, Texas, recent cities that have contracted with Healthways to make structural changes to spur better health. The Blue Zones idea comes from the discovery of the five places in the world where citizens live the healthiest and longest lives because of exercise (walking most places), nutrition (more plant-based diets), and social connectedness.

 

We have the ingredients here in Tulsa to take on such a challenge, and working through the updated Community Health Improvement Plan that will soon be released by the Tulsa Health Department, we can all choose to live healthier lives — both individually and as a community.

 

Amazingly, we can do all of this regardless of our need to interact with our “health care system.”

 

Note: This essay appeared as an op-ed in today’s Tulsa World

Caring Center is a Win-Win

Bama stacks wwwThe Bama Companies of Tulsa, Okla. made what I see as an historic announcement last month.

The company, a privately-owned global manufacturer of pies, biscuits (McDonald’s) and dough (Pizza Hut) has more than 1000 employees.

CEO Paula Marshall believes in second chances, making a practice of hiring parolees and those (particularly women) out of treatment for chemical dependency.

Marshall noted that there is a critical threshold, at 3-4 months of employment, where tardiness and absenteeism start to occur in many of these new hires — often resulting in termination or resignation.

Since it’s costly for the company to recruit and train new talent (Marshall puts the number at $5500 per employee), she figured it is wise to invest in helping employees surmount the challenges they face in maintaining employment — factors outside the workplace — like childcare, financial planning, transportation, and counseling.

[For decades the company has offered in-house medical services, which will continue with the new initiative.]

The company frames the decision to open it’s “Caring Center” as a business decision, but it’s clearly one with a heart.

To me, the plan reinforces the idea that it’s not strictly what happens within the walls of a medical setting that impacts people’s health. It’s the social determinants of health that have a bigger impact on health– education, environment, employment, access to adequate nutrition.

Opinions on the project vary. Some say Bama’s ‘Caring Center’ is nothing more than a glorified Employee Assistance Program (EAP). But in my view, EAPs are usually handled by 3rd party contractors, have limited uptake, and are focused more exclusively on mental health (important, to be sure, but not as broad as Bama’s effort).

Others ask, “Why not simply pay the employees more?” That is indeed a laudable goal. But arguably it’s the educational efforts and resource-matching that the Caring Center provides that will make more of a difference in employment sustainability. If an employee can keep his/her job, s/he will have more opportunity to climb the economic ladder. Bama, for example, like many companies, seeks to retain and grow talent from within.

Only time will tell if Bama’s Caring Center is impactful or not. Marshall has set the bar at what seems like an achieveable level: She hopes to lower the rate of employee loss from 8/10 to five or six out of ten to achieve financial success for the company. But if she succeeds, that’s many lives that will be impacted.

Will more companies choose to make these types of investments?

© 2017 GlassHospital

Theme by Anders NorenUp ↑