Fred Turner: To fix U.S. health care, we must redefine what health means

By Fred Turner

America’s health care system is sick.

The COVID-19 pandemic helped expose the symptoms, which include shortages of staff and equipment, a widespread prevalence of preventable chronic conditions, and unequal access to care.

But the causes of our system’s sickness run deeper and aren’t new. A 2019 Gallup poll found that 70% of Americans thought our health care system was “in a state of crisis.” And that was before the pandemic.

The solution lies in a wholesale change of attitude – beginning with a new definition for the very concept of “health.”

The U.S. medical community has long understood health as the absence of disease – and has seen treating disease as its primary mission. But health care should begin long before illness is in sight. We need to transform care so it’s patient-centered, personalized, and cognizant of social and environmental determinants of health.

In virtually every other sector of the economy, services are built to cater to the customer. In health care, they’re more often designed to suit providers and payers. That means too many patients, even those with good insurance, have trouble accessing the health care services they need.

Consider that the average wait time for a first-time visit with a physician in the United States is three weeks. In some cities, patients can expect to wait nearly two months to see the doctor. And even among patients with insurance, nearly half say it’s difficult to afford their out-of-pocket medical costs.

Too many hospitals and doctors’ offices are uncomfortable, even though research shows the physical design of these spaces can have significant effects on patients’ stress levels, recovery times, and whether they develop infections.

Personalization, meanwhile, means recognizing that no two patients have the same needs. Presented with a physical symptom, providers have to consider whether a prescription is in order, or perhaps another less conventional intervention. That could mean getting fresh groceries to a patient in a food desert so they can cook healthy meals, helping someone leave an abusive relationship, or providing remote counseling to someone whose health problems are the result of stress.

Personalized care can also address a range of social factors that drive health outcomes. Economic and cultural factors often correlate with susceptibility to disease and the presence of underlying conditions. Consider that people of color are more likely to live with diabetes, heart disease, and obesity than white Americans.

These are the same groups disproportionately impacted by the COVID-19 pandemic. Black and Hispanic people, for example, are about twice as likely to die from COVID-19 than whites. To solve these disparities, we need to design systems that look at a community holistically and are sensitive to things like living environment, education level, gender, and race.

Someone struggling with asthma may need an inhaler. But they also might benefit from linking up with a community organization that can help them address mold or poor ventilation in their home.

A system that treats patients within their community would also help physicians connect patients with other nonmedical resources when appropriate, like social workers, therapists, or life coaches. The right course of treatment for someone with high blood pressure, for example, may be medication. But it could also be connecting them with another professional who can help address the stress or environmental cues causing their condition.

Technology can make delivering this kind of personalized, patient-centered care possible and scalable. Today, getting in touch with a doctor or scheduling an appointment can be as simple as sending an email or shooting off a text. There’s no reason our health care system can’t fully embrace that level of service.

Or imagine if our doctors and health plans could catch health problems before we even had an inkling of them. Remote-monitoring technology, combined with highly accessible health care providers, could enable as much.

America’s health care system has been failing patients since long before COVID-19. To fix the flaws, we must build institutions that look at people holistically – with the goal of fostering physical, mental, and social well-being.

Fred Turner is co-founder and CEO of Curative, which provides on-demand public health service programs.