What is sustainable healthcare?
The Alliance for Natural Health has defined sustainable healthcare in the following way.
A complex system of interacting approaches to the restoration, management and optimization of human health that have an ecological base, that are environmentally, economically and socially viable indefinitely, that work harmoniously both with the human body and the non‐human environment, and which do not result in unfair or disproportionate impacts on any significant contributory element of the healthcare system.
Alliance for Natural Health (http://www.anh-europe.org)
Based on this definition, there is very little about our existing healthcare system that is sustainable. To achieve sustainability, it is necessary to look beyond what we have now to what we really want. Universally people want to live vital healthy lives. A system designed to keep people healthy would meet all the criteria stated in the definition above. Interestingly, keeping people healthy costs a fraction of maintaining them in illness (which is what our current system does). I think everyone knows this because they know they want to be healthy, but I don’t think people realize how achievable it is.
Without question, we have the medical/scientific knowledge to keep the vast majority of people healthy. We have solid understanding of bacterial and viral infections that used to wipe out whole populations. We already know how to prevent most heart disease, diabetes, cancer, asthma and other high cost, serious disease. We understand fully the toxic impact of environmental poisons on health and the cancers, breathing disorders, nutritional impacts, cell mutations, etc. that they cause. They are all preventable. We also understand the social determinants of health like poverty, malnutrition, poor housing, lack of heat, violence, injustice, inequality. These all have gross effects on health and this is well acknowledged. It turns out that to keep people healthy, we have to fix life, and that is not so simple. But is it do-able? Could we do more now? Unequivocally yes, there is a great deal within reach and within short order. But there are some definite barriers to effecting the changes that would keep us healthy and those need attention.
The first order of priorities is that we now run a healthcare infrastructure that is not remotely geared to keeping us healthy. To the contrary, it is a system that is completely dependent on a steady stream of sick people to maintain it. Our physicians, hospitals, clinics, pharmaceutical companies, health insurers, etc. all make a lot of profit out of sick people. Even the not-for-profit institutions (like many hospitals) pay a lot of people a lot of money just to operate them. Without so many sick people, many would go out of business. The profit motive in sick care is counter-productive and its purveyors probably will not willingly adopt changes that threaten profits and livelihood. This infrastructure is truly unsustainable and to a great extent unnecessary since the majority of illness is preventable.
The next order of priorities is the mindset that supports the current system. Those of us who actively keep ourselves healthy have a mindset that tells us that we have the ability to do this. We like to feel vital and strong so we take steps to keep it that way. When we do get sick (which everyone does sometimes) or have accidents, we seek help but we do so with discrimination. We go to a physician or therapist, seeking not a fix but a collaboration, always maintaining ownership of our health. The existing healthcare infrastructure is not geared for this. It is geared for people who are passive and seek pill or procedure to provide a fix. The paternalistic nature of the healthcare system is a hold-over from the Industrial Revolution and has been slow to be superseded. Supersede we must however, as passive participation leaves individuals and whole communities vulnerable to be milked for on-going, massive amounts of healthcare expenditure. The onus is on individuals and communities to take back ownership of their health because it does not look like the existing infrastructure is going to give up their ownership willingly.
The question gets down to what we can do now in the face of the mindset and infrastructure barriers that actually work against us keeping people healthy. The answer is we can do it all, but it takes courage, unity and working both as individuals and in groups.
Many individuals already have ownership of their health. The knowledge of how to do this is freely available in libraries, on the internet, in community settings, in schools, etc. It is all over the place. But not all problems can be addressed as individuals. Many require groups to come together and solve problems as a community. This is a factor that we have been slow to incorporate into our thinking of what creates health. Our healthcare system treats people individually and problems in isolation: a person separate from their family or social group, a bad back in isolation from the cause, a sore belly in isolation from a sore heart. The group and interdependent nature of health is critical to sustainability. There are some superb examples of how communities have taken ownership of their health in the USA today. Fare Start in Seattle (www.farestart.org) is an excellent social program that generates a lot of health for the homeless. Central City Concern in Portland (www.centralcityconcern.org/ ) is another example of a program for the homeless that generates health by demonstrating the inextricable interplay of physical, emotional, social, economic and knowledge elements of creating sustainably healthy people. A third example is Home Boy Industries in Los Angeles (http://www.homeboy-industries.org/ ). Their motto of “nothing stops a bullet like a job” says a lot but the whole program recognizes the holistic nature of health that is not divisible from social structures like gangs, poverty and inequality. Another model program is the Harlem Children’s Zone (http://www.hcz.org/ ). Harlem as a community, under the leadership of Geoffrey Canada has taken ownership of the health and well-being of the children thus the families of their neighborhood. As a group, they are able to overcome tremendous odds and create vitality and sustainable outcomes.
Sustainable healthcare is achievable now, at (relatively) little cost and with existing knowledge. (The cost of one MRI machine would fund a community health effort for 2 years.) This does not discount the many very sick people who need and benefit from the existing system. It does say however that many of them should never have gotten so sick and many could be much healthier thus greatly reduce their need of the system if we had a commitment to health.
Here is how it can work now. It is a simple formula for the goal of keeping healthy.
- Groups of people unify, recognize themselves as a community and begin to solve their health problems together. Groups can be a business, a socio-cultural aggregation, a geographical consortium, etc. It can be any conglomeration of people who can come together and hold a shared vision for a healthy life.
- Health coaches work with individuals and groups to raise awareness, provide education, help people find appropriate support where needed, and importantly, promote an ownership and self-responsibility mindset.
- Physicians and therapists are trained to collaborate instead of use a passive patient/authoritative expert model of care.
Any group that does these 3 things will rapidly increase the health of individuals and the group as a whole. Notice that there is very little cost involved, mainly training of health coaches and providers. Social organizing is a well-understood process and is the foundation of #1. This is very do-able. It is being demonstrated all over the world currently and has been demonstrated historically. Is it easy? No, it is challenging, but why would that be a reason not to do it? What we have is unsustainable, and more importantly, does not generate health.
The key salutary point on the question of sustainable healthcare and cost is that up to 90% of the current system is either unnecessary or inappropriate. In a system focused on health, we would be awash in dollars and energy if reclaimed from the existing system. We do not need to figure out how to maintain our system, rather how to transition out of most of it. That transition is largely a thought process, not a budget line item.
Author information: Kim Adams is an RN, has had a 30 year career in healthcare in virtually every aspect of its infrastructure, is a professional organizational change agent and collaborates to make health focused change with a team of physicians, social workers, economists, psychologists and others deeply committed to the well-being of all life on earth and the earth itself.