Cel­e­brate the ad­vances of mod­ern medicine, but com­mit to heal­ing other long-term ills

Modern Healthcare - - COMMENT - By Dr. Jonathan Per­lin Dr. Jonathan Per­lin is chair­man of the Amer­i­can Hos­pi­tal As­so­ci­a­tion and pres­i­dent of clin­i­cal ser­vices and chief med­i­cal of­fi­cer at HCA.

If some­one claimed they could cut the death rate among Amer­i­cans un­der age 75 by al­most half over the next four decades, it would be big news. Yet re­search shows that this has ac­tu­ally hap­pened over the past 44 years.

Be­tween 1969 and 2013, deaths from all causes de­creased an as­ton­ish­ing 43%, ac­cord­ing to a re­cent re­port pub­lished in JAMA. Why? While pub­lic health pro­grams, vac­ci­na­tions and the in­tro­duc­tion of an­tibi­otics in­creased longevity be­fore 1969, bet­ter preven­tion, new med­i­ca­tions, ad­vanced tech­nolo­gies and the so­phis­ti­cated care that mod­ern hos­pi­tals of­fer pro­vide the rest of the an­swer.

Peo­ple with con­di­tions that once spelled al­most cer­tain pre­ma­ture death, es­pe­cially stroke and heart dis­ease, are now sur­viv­ing. More­over, they are do­ing so with­out los­ing the func­tions that lend qual­ity to their lives, al­low­ing them to con­tinue to con­trib­ute to so­ci­ety. In 1969, heart at­tacks were treated with rest, if the vic­tim sur­vived. Strokes, es­sen­tially “heart at­tacks of the brain,” could not be treated. To­day, Amer­ica’s hos­pi­tals pro­vide the emer­gency and crit­i­cal care that al­lows pa­tients not only to sur­vive con­di­tions that would have meant cer­tain death four decades ago, but also to main­tain—and some­times even im­prove—their health.

But there is much more work to do. Yes, we have made great progress in pre­vent­ing heart dis­ease and stroke through bet­ter blood-pres­sure con­trols and re­duced tobacco use, but we have lost ground to in­creas­ing waist­lines. A re­cent Cen­ters for Dis­ease Con­trol and Preven­tion study found that adult obe­sity is on the rise, par­tic­u­larly among women. Obe­sity pre­dis­poses us to higher rates of diabetes, and in turn, kid­ney dis­ease, heart dis­ease and stroke. Sadly, if we can’t quickly re­duce our obe­sity rate, Amer­ica’s youth will not live as long as their par­ents. That should give us ex­tra­or­di­nary mo­ti­va­tion to fo­cus on this na­tional cri­sis.

To truly “bend the cost curve” and spend less on health­care as a coun­try, we must be­come a health­ier so­ci­ety. Too much of Amer­ica’s health­care dol­lar is di­rected to­ward re­cov­er­ing from the rav­ages of chronic dis­ease. Many of those diseases are fun­da­men­tally pre­ventable and con­trol­lable, yet cat­a­strophic and ex­pen­sive when ne­glected.

Chronic dis­ease in the U.S. is not just a mat­ter of na­tional eco­nomics but per­sonal fi­nance. In fact, bad health—from heart dis­ease to diabetes to asthma—dis­pro­por­tion­ately af­fects the poor and mi­nor­ity pop­u­la­tions. Through ef­forts to re­duce dis­par­i­ties in care and ac­cess to health ser­vices, the Amer­i­can Hos­pi­tal As­so­ci­a­tion, along with other or­ga­ni­za­tions across the coun­try, are work­ing hard to ad­dress th­ese vex­ing chal­lenges. The goal is not only eq­uity of care, but ul­ti­mately, eq­uity of health and a health­ier so­ci­ety.

De­spite mod­ern medicine’s ad­vances and our na­tion’s best ef­forts to pre­vent dis­ease, se­ri­ous ill­nesses re­main in­evitable, and the num­ber of peo­ple liv­ing with chronic con­di­tions is grow­ing. Hos­pi­tals are in­creas­ingly mov­ing out­side of their tra­di­tional walls to im­prove com­mu­nity health and foster over­all well­be­ing. To­day, you see more or­ga­niza- tions work­ing with in­di­vid­u­als and fam­i­lies to en­sure they have healthy food to eat, a safe place to sleep, trans­porta­tion to needed health ser­vices and so much more.

This is an ex­cit­ing time for the in­dus­try. We’ve mapped the hu­man genome, so we can now understand diseases not only by know­ing what or­gan sys­tem they strike or what they look like un­der a mi­cro­scope, but we can com­pre­hend and al­ter the bi­ol­ogy of dis­ease at a molec­u­lar level.

And, thanks to the im­ple­men­ta­tion of elec­tronic health records in hos­pi­tals and other health­care set­tings, we can in­creas­ingly har­ness “big data” to pre­dict how diseases and ill­nesses such as sep­sis will be­have, and de­sign in­ter­ven­tions tai­lored to the in­di­vid­ual pa­tient, as we usher in the era of pre­dic­tive, pre­ci­sion and per­son­al­ized medicine.

Con­tin­u­ing to help peo­ple lead lives that are not only longer but health­ier re­quires the con­tin­ued avail­abil­ity of so­phis­ti­cated health­care in ev­ery com­mu­nity. Fun­da­men­tally, ac­cess to care is a pre­req­ui­site for health. Ev­ery Amer­i­can de­serves ac­cess to the right care in the right place at the right time. But to bet­ter pre­vent dis­ease in the first place, we also need to in­vest in our own health and cre­at­ing a health­ier so­ci­ety.

In­vest­ment in our health is not only an in­vest­ment in the lifeblood of our coun­try, it is a com­mit­ment to con­tin­ued progress over the next 44 years.

In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? View guide­lines at mod­ern­health­care.com/op-ed. Send drafts to As­sis­tant Man­ag­ing Ed­i­tor David May at dmay@mod­ern­health­care.com.

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