As most everyone knows, the United States spends more on healthcare than any other developed nation and yet suffers from some of the worst outcomes including a shorter life expectancy, which continues to fall behind other nations.
The United States has the classic 80/20 rule backward. Our nation spends 80% on healthcare and only 20% on prevention. Addressing the social determinants of health, namely the environmental factors that lead to disease, would not only reverse the 80/20 ratio but also decrease the total amount spent. The result would be more productive people with most living longer, thereby freeing up resources for other altruistic and noble pursuits, such as education, infrastructure, culture, recreation, and entertainment.
The federal government, like it or not, is the largest purchaser of healthcare. Much of the federal funding is determined by individual states that can implement creative payment policies such as offering food or housing to improve well-being. Thus, both federal and state governments can and do encourage prevention.
Medicaid policies vary by state, but seven strategies advocated by Manatt Health, The Health Initiative, The Commonwealth Fund, and Blue Shield of California Foundation would help everyone.
- COVID-19 exacerbated pre-existing environmental deficiencies such as food deserts, social isolation, inequities, transportation challenges, and other faults. Inspiringly, certain communities with pre-existing lower incidences of lung disease, diabetes, and hypertension were more resilient. These same communities had greater social connectivity and thus had better mental health outcomes. Specific details about these Blue Zones Project regions are outlined in Community Resiliency to COVID-19 in a Subset of US Communities.
- Payment policy can incorporate tools to address prevention and disease avoidance rather than relying on traditional funding for treatment. An ounce of prrevention is worth a pound of cure.
- Integrating resources focused on healthy behaviors has been shown to be very effective as evidenced by the sixty-plus and growing Blue Zones Project communities. Measurable long-term improvements have been demonstrated across the socio-economic spectrum.
- Participation in already existing and effective public programs such as the Supplemental Nutritional Assistance Program (SNAP) and other similar initiatives directed to women, infants, and children should be extended.
- Metrics matter; many good systems already exist but are not fully distributed or leveraged. Having easily defined goals helps everyone manage limited resources. The Community Well-Being Index is the most comprehensive set of contemporaneous analytics ever created.
- Innovation based on objective results should be encouraged. Copying others’ successes accelerates progress efficiently. An excellent example is the Blue Zones Project in which 60+ communities share best practices and constantly evolve, with the goal of helping everyone live a longer, happier, and healthier life.
- Incentivizing communities to embrace health and well-being will encourage emulation. Sharing success is beneficial for both the giver and receiver. The same is true on a larger scale for entire communities. Growing a self-perpetuating cycle for community well-being and health multiplies the success.
Opportunities abound for regions, states, and the nation to embrace well-being and health.