Healthcare is not about health

Abstract

Initiatives designed to reduce the disease burden and improve the health of the US population that focus on increasing access to health care have been disappointing. Progress requires multifaceted change. We must first acknowledge that the healthcare system is focused on reversing or modifying disease, not enhancing health. Our conceptualization of the development of ill health and disease must also change. Scientific advances are clarifying the complex interactions among the development of ill health and disease and an individual's behaviors, their microbiota, and their physical, social, and emotional environments. A person's genetic makeup predisposes them to a wide array of disease conditions but is rarely deterministic in and of itself. Factors extrinsic to the individual, including the social determinants of health, play a major role in disease development, often decades later. The complexity of health and disease requires a "team" accountable for the health of our populations, and these teams must be expanded beyond the medical professions. Governmental officials, architects, business leaders, civic organizations, social and neighborhood groups are among the key stakeholders on the health side of the equation. If and when disease does become manifest, then the care part of the healthcare system assumes the larger role. This has major implications for the education of our clinically focused health science students, but also of professional disciplines previously deemed peripheral to health. Simply redoubling our efforts and focusing on our current healthcare system is insufficient to make progress in the health of the populace. One example of a multipronged approach in Allentown, PA is explored in depth.

Keywords: behavior; disease; environment; health; healthcare; mental model; microbiota; new paradigm; social determinants of health.

FIGURE 1

The conceptualization of health. The contributing factors to an individual's health and eventual progression to disease include both intrinsic and extrinsic influencers often not considered by current healthcare professionals. For an individual the contributions of each factor will vary but, as depicted, clinical care is modest compared to other components.

FIGURE 2

Centered on the community, multiple entities and groups bring their expertise and authority to bear on factors leading to ill health and disease in Allentown neighborhoods. Pool Fellows, as embedded leaders, facilitate community structure relationships.