Shift medicine’s focus to making patients healthy

There is a clinic in northwest Houston that treats children who have asthma. The clinic follows appropriate medical protocols, prescribing medications to improve lung function and reduce the severity of asthma attacks. Yet some patients still experience severe asthma attacks that send them back to the clinic repeatedly, or even to the hospital.

The doctor suspects that the attacks are triggered by mold or other conditions in the children’s homes. What is the responsibility of the clinic in this situation? Is it simply to prescribe medicine, or is it to figure out why patients continue to suffer and do something about it? Is our health system responsible for delivering health or just health care? And do we know the difference?

We Americans have confused health with health care. We use the words interchangeably; we talk about health care as if it were the same thing as health. We have a pretty good

grasp on health care: hospitals, clinics, physicians, nurses, labs, MRIs, surgery and pharmaceuticals. High tech, increasingly expensive. Health is a broader concept: in the words of the World Health Organization, health is a state of physical, mental and social well-being and not merely the absence of disease or infirmity.

Health care is a means to an end, and that end is health. Yet we talk about health care as if it were the same as health, so we miss opportunities that fall outside of the healthcare paradigm.

Many factors contribute to good health. In fact, research shows factors like income, education, housing, community safety, individual behaviors and the environment account for 80 percent of health outcomes, while health care accounts for only 20 percent.

Every year, $3.3 trillion is spent in the United States on health-related costs, more than any other country. This includes payments by government, businesses and families for hospitals, doctors and prescription drugs. That amounts to 17.9 percent of gross domestic product — almost one-fifth of our economy. Of that $3.3 trillion, 97 percent is spent on health care. If health care accounts for only 20 percent of health outcomes, should we be directing 97 percent of health-related dollars to health care?

And yet, our health outcomes lag those of nearly every other developed country. Countries with better health outcomes spend a smaller percentage of GDP on health than we do and devote a larger share of GDP to social spending — including those factors that account for 80 percent of health outcomes.

America lags in health outcomes because we incentivize the health sector to focus on health care instead of health. Unless we pay to deliver health, we’ll continue to focus on providing health care. It doesn’t have to be this way.

We must redirect some of our $3.3 trillion to factors that are more influential on health, by insisting that our dollars are spent on improvement in health outcomes rather than delivery of medical services.

That Houston clinic decided its responsibility was to make kids healthy. They would no longer send patients home with medications knowing that the real solution lay outside the clinic. Clinic staff began visiting patients to find and fix the asthma triggers. The clinic is now working with an insurance company that understands home repair is the best medicine for some patients. We can accelerate this kind of change by making the conversation about health, not just health care.