[{"innerBlocks":[],"name":"core\/freeform","postId":125969,"blockType":{"name":"core\/freeform","keywords":[],"attributes":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"providesContext":[],"usesContext":[],"selectors":[],"supports":{"className":false,"customClassName":false,"reusable":false},"styles":[],"variations":[],"apiVersion":3,"title":"Classic","description":"Use the classic WordPress editor.","category":"text"},"originalContent":"I\u2019m not sure what the relevant analogy might be, but I\u2019ll take a shot nonetheless.

Let\u2019s say we poured billions of dollars into improving highways and city streets, but the local commute for residents continued to get longer, more frustrating and less effective.

Or try this\u2014maybe we also dumped billions of dollars into school systems, but student test scores only got worse.

I ask if these comparisons are relevant after reading about a recent study published in the Lancet, which suggests that poor diet and lack of exercise kill more people globally every year than even smoking, the go-to bogeyman for all negative health indicators.

For all the truckloads of cash we continue to push toward improving medical technology and technique, building different organizational structures and making Crocs mandatory healthcare footwear, the biggest bang for the buck remains diet and exercise.
How unsexy is that?

What the evolution of transportation, education and healthcare in the United States all demonstrate is that more money does not equal better overall outcomes. It\u2019s not like this is a recent revelation.

\u201cThe United States spends more on healthcare than any other nation in the world, yet it ranks poorly on nearly every measure of health status. How can this be? What explains this apparent paradox?\u201d asked Steven A. Schroader, MD, in a 2007 New England Journal of Medicine article. \u201cThe two-part answer is deceptively simple\u2014 first, the pathways to better health do not generally depend on better healthcare, and second, even in those instances in which healthcare is important, too many Americans do not receive it, receive it too late or receive poor-quality care.\u201d

Schroader is telling us that we\u2019ve equated better healthcare with better health\u2014but, by contrast we should be looking at better choices\/options and access to necessary care as the essential keys to a healthier population.

What would that look like in practice? More focus on population health and universal health insurance and less on perfecting physicians using carrots and sticks.

Instead we have a healthcare system that asks physicians to click hundreds of boxes in electronic health records systems, with little evidence that the constant clicking creates better outcomes. Indeed, one could argue that our current goal of improving the provision of care is misplaced, making the strategy (clicks) used to get there irrelevant.

\u201cFor starters, we know that 70 percent to 90 percent of health outcomes are determined by socioeconomic and lifestyle factors,\u201d writes W. Ryan Neuhofel, DO, in a recent issue of the New England Journal of Medicine. \u201cAppropriate healthcare, particularly primary care, can tilt the odds toward better outcomes through medical intervention, lifestyle guidance and advocacy. Primary care can improve individual lives and help budgets by reducing the likelihood of more expensive downstream care.\u201d

This is not to say that healthcare shouldn\u2019t be working to improve its overall delivery by eliminating errors and making it easier to identify the most appropriate patient treatment. But the potential for the greatest improvement for the greatest number of patients\/citizens lies in the thousands of daily choices that don\u2019t directly involve a doctor.

Looking again at the study in the Lancet, researchers found that citizens of countries that follow a Mediterranean diet\u2014whole grains, fruits and vegetables, heart-healthy fats and small amounts of lean protein\u2014are the healthiest. Israel came in first, followed by France (no, they don\u2019t eat triple-cream brie, baguette and Bordeaux at every meal) and Spain. The U.S. ranked 43rd.

According to study estimates, we can attribute 3 million global deaths annually to too much salt, another 3 million to too few whole grains, and still 2 million more to not enough fruit.

Perhaps, America is just too much about the specific. We\u2019re working to develop personalized medicine. We dream of individual genetic profiles and miraculous stem cell therapies. We\u2019re trying to develop healthcare IT systems that are customizable to the particular needs of the clinician.

Again, these efforts are not inherently bad, but neither are they the keys to improving health for wide swaths of the public, any more than is a strict blueberry diet.

\u201cI love blueberries, wild and cultivated, but they are a fruit like any other,\u201d writes professor and author Marion Nestle. \u201cTheir antioxidants may counteract the damaging actions of oxidizing agents (free radicals) in the body, but studies of how well antioxidants protect against disease yield results that are annoyingly inconsistent. When tested, antioxidant supplements have not been shown to reduce disease risk and sometimes have been shown to cause harm.\u201d

Like blueberries and the human body, healthcare IT systems are not a cure for all that ails the body medical. We\u2019ll eventually develop EHRs that doctors like to use, but if they don\u2019t somehow create unforeseen behavioral changes en masse, the health of the general American populace will remain stubbornly low on a global scale.

Where linked computer systems really excel, however, is in the collection of large amounts of data and identification of trends. Sure, an EHR may remind Dr. Smith that Mrs. Jones is allergic to penicillin, and that will be great for Mrs. Jones and for Dr. Smith, but it will do little for overall health and mortality rates.

So, healthcare IT platforms have to remind Dr. Smith of crucial information about Mrs. Jones AND collect information to be used for information campaigns, vaccination efforts and resource allocation decisions. They need to alert an ER doc to this particular patient\u2019s opiate addiction AND public health officials of a spike in measles cases. Integrated IT systems can also provide data on social determinants of health like income and family situation, which reliably predict illness across communities.

These systems need to contribute to making both healthcare and health better, but they\u2019re virtually powerless without good policy, effective implementation and comprehensive education.

Improvements in health and reductions in healthcare costs will come from several different inputs, including sound public health policy, preventive care, comprehensive insurance coverage, better personal choice and integrated healthcare IT.

In absence of these complementary factors, we\u2019re left to hope that those blueberries really are a miracle cure.","saveContent":"I\u2019m not sure what the relevant analogy might be, but I\u2019ll take a shot nonetheless.

Let\u2019s say we poured billions of dollars into improving highways and city streets, but the local commute for residents continued to get longer, more frustrating and less effective.

Or try this\u2014maybe we also dumped billions of dollars into school systems, but student test scores only got worse.

I ask if these comparisons are relevant after reading about a recent study published in the Lancet, which suggests that poor diet and lack of exercise kill more people globally every year than even smoking, the go-to bogeyman for all negative health indicators.

For all the truckloads of cash we continue to push toward improving medical technology and technique, building different organizational structures and making Crocs mandatory healthcare footwear, the biggest bang for the buck remains diet and exercise.
How unsexy is that?

What the evolution of transportation, education and healthcare in the United States all demonstrate is that more money does not equal better overall outcomes. It\u2019s not like this is a recent revelation.

\u201cThe United States spends more on healthcare than any other nation in the world, yet it ranks poorly on nearly every measure of health status. How can this be? What explains this apparent paradox?\u201d asked Steven A. Schroader, MD, in a 2007 New England Journal of Medicine article. \u201cThe two-part answer is deceptively simple\u2014 first, the pathways to better health do not generally depend on better healthcare, and second, even in those instances in which healthcare is important, too many Americans do not receive it, receive it too late or receive poor-quality care.\u201d

Schroader is telling us that we\u2019ve equated better healthcare with better health\u2014but, by contrast we should be looking at better choices\/options and access to necessary care as the essential keys to a healthier population.

What would that look like in practice? More focus on population health and universal health insurance and less on perfecting physicians using carrots and sticks.

Instead we have a healthcare system that asks physicians to click hundreds of boxes in electronic health records systems, with little evidence that the constant clicking creates better outcomes. Indeed, one could argue that our current goal of improving the provision of care is misplaced, making the strategy (clicks) used to get there irrelevant.

\u201cFor starters, we know that 70 percent to 90 percent of health outcomes are determined by socioeconomic and lifestyle factors,\u201d writes W. Ryan Neuhofel, DO, in a recent issue of the New England Journal of Medicine. \u201cAppropriate healthcare, particularly primary care, can tilt the odds toward better outcomes through medical intervention, lifestyle guidance and advocacy. Primary care can improve individual lives and help budgets by reducing the likelihood of more expensive downstream care.\u201d

This is not to say that healthcare shouldn\u2019t be working to improve its overall delivery by eliminating errors and making it easier to identify the most appropriate patient treatment. But the potential for the greatest improvement for the greatest number of patients\/citizens lies in the thousands of daily choices that don\u2019t directly involve a doctor.

Looking again at the study in the Lancet, researchers found that citizens of countries that follow a Mediterranean diet\u2014whole grains, fruits and vegetables, heart-healthy fats and small amounts of lean protein\u2014are the healthiest. Israel came in first, followed by France (no, they don\u2019t eat triple-cream brie, baguette and Bordeaux at every meal) and Spain. The U.S. ranked 43rd.

According to study estimates, we can attribute 3 million global deaths annually to too much salt, another 3 million to too few whole grains, and still 2 million more to not enough fruit.

Perhaps, America is just too much about the specific. We\u2019re working to develop personalized medicine. We dream of individual genetic profiles and miraculous stem cell therapies. We\u2019re trying to develop healthcare IT systems that are customizable to the particular needs of the clinician.

Again, these efforts are not inherently bad, but neither are they the keys to improving health for wide swaths of the public, any more than is a strict blueberry diet.

\u201cI love blueberries, wild and cultivated, but they are a fruit like any other,\u201d writes professor and author Marion Nestle. \u201cTheir antioxidants may counteract the damaging actions of oxidizing agents (free radicals) in the body, but studies of how well antioxidants protect against disease yield results that are annoyingly inconsistent. When tested, antioxidant supplements have not been shown to reduce disease risk and sometimes have been shown to cause harm.\u201d

Like blueberries and the human body, healthcare IT systems are not a cure for all that ails the body medical. We\u2019ll eventually develop EHRs that doctors like to use, but if they don\u2019t somehow create unforeseen behavioral changes en masse, the health of the general American populace will remain stubbornly low on a global scale.

Where linked computer systems really excel, however, is in the collection of large amounts of data and identification of trends. Sure, an EHR may remind Dr. Smith that Mrs. Jones is allergic to penicillin, and that will be great for Mrs. Jones and for Dr. Smith, but it will do little for overall health and mortality rates.

So, healthcare IT platforms have to remind Dr. Smith of crucial information about Mrs. Jones AND collect information to be used for information campaigns, vaccination efforts and resource allocation decisions. They need to alert an ER doc to this particular patient\u2019s opiate addiction AND public health officials of a spike in measles cases. Integrated IT systems can also provide data on social determinants of health like income and family situation, which reliably predict illness across communities.

These systems need to contribute to making both healthcare and health better, but they\u2019re virtually powerless without good policy, effective implementation and comprehensive education.

Improvements in health and reductions in healthcare costs will come from several different inputs, including sound public health policy, preventive care, comprehensive insurance coverage, better personal choice and integrated healthcare IT.

In absence of these complementary factors, we\u2019re left to hope that those blueberries really are a miracle cure.","order":0,"get_parent":{},"attributes":[],"attributesType":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"dynamicContent":""}]

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