The Scandal of Healthcare Metrics
We have all gladly put Volkswagen to shame for tweaking technology to say that its cars are environmentally friendly, rather than actually lower the the nitrogen oxide emission. I think the whole healthcare industry has been just as guilty for doing the same thing for decades.
Hospitals are trying to report less readmissions, diabetic apps try to show that users have lower glucose levels and fitness apps congratulate us about making more steps. These are all attempts to hide manifestations of disease, rather than tackle the deep-routed social issues which cause the dysfunction.
It is a fact that Healthcare outcomes are still not up to par with how we would like them to be. While most organizations are trying to push for an improve in outcomes, some interesting entrepreneurs are actually measuring health in a totally novel way, which is alien to the industry, but arguably makes more sense.
I was taught in medical school that healthcare starts with a state of biochemical imbalance conveyed as signs and symptoms that can be labelled as a diagnosis, which requires investigations, a treatment plan and follow up. After joining a hospital, I learned that the whole system was incentivized to have more sick people, rather than less.
This counter-intuitive idea can explain doctors’ frustrations, patients’ lack of well being and even the reluctance of hospitals to share data. From a manger’s perspective, having less doctors see more patients while owning the patient’s data exclusively means good business. It also means an outrageously expensive and fragmented healthcare system.
This is not a problem of managers per se but one of policy and funding priorities. The recent epiphany is that the problem may lie in how we define health to begin with. Research shows that the whole healthcare system only accounts for 20% of a community’s health. Equally determinant is the genetic makeup (also at 20%), while the main constituents for health (60%!) are environmental and behavioral factors.
“We’re at a point where there is a battle of ideologies” says Pritpal S Tamber, a UK based doctor and physician editor of TEDMED 2013. “Healthcare has a narrow lens on what health is; it’s bio-medical plain and simple. That is a very slim definition of what people and communities look for in health.” He said to a very engaged audience at Exponential Medicine 2015.
Pritpal S Tamber inspires the crowd with his community oriented approach to health care
Pritpal is the founder of Creating Health Collaborative, which supports entrepreneurs to work on projects that explore and deliver health beyond the lens of health care. It often means strengthening and leveraging the idea of civic engagement to get communities to express what and how they see their health.
So where do the healthiest communities live in the world? Let me direct your attention to the impressive case of Okinawa, an island in Japan known for it’s communities’ measurably long and arguably happier lives. Okinawa does not have more hospitals, better technology, big data or “patient-centric healthcare delivery”. What they have is much simpler: A very strong sense of community and long hours of sleep. They also live on a low meat diet, are generally active, and have a lot of festivals.
Okinawa has one of the oldest and happiest populations in the world
Similarly, there are other spots in the world that just live longer lives and have similar traits and are characterized by their community and habits. A whole list is available about the National Geographic-led research on these areas, dubbing them the Blue Zones.
“It is simple, we want a healthy happy long life with lots of love and no regrets. Why shouldn’t these become our health indicators?!” says Alex Jaddad, a pain physician and Founder of the Centre for Global eHealth Innovation at the University of Toronto. “We are trapped by an evidence-based paradigm, which I was a part of myself. We need to extradite ourselves from this idea, and provide precision medicine that is based on how the patient feels.”
Alex Jaddad speakes to a very engaged audience in #xmed
There are more and more tools being available to measure what are called “Social Determinants of Health.” One example is the Life Change Index Score created by Dartmouth university to quantify how certain life events (such as divorce or losing a loved one) affect our likelihood of disease. It is still limiting to see social factors from that biomedical lens, but this is a good start to recognize and address these factors.
Health 2.0 is all about changing how we look at traditional medicine and health care. One of the most popular sessions at the Fall Conference is called “The Unmentionables” where technologies which transform patients’ lives by targeting poverty, sex, emotional well being and other uneasy topics are showcased.
Unmentionables sessions by Alexandra Drane during Health 2.0’s Fall Conference
Alexandra Drane started it off this year by showing that people who had some of these life factors where 2.6 times more likely to develop chronic diseases such as Diabetes, a metric they called the “Vulnerability Index”.“It is time to stop admiring this problem and start putting it out of business.” as Alexandra Drane placed it.
Companies like Honor and Seniorlink empower caregivers to actually get paid while doing what they love without being marginalized and underpaid as they are now with 60% of them on government assistance. TrueLink, a credit card that helps elderly patients with dementia control their finances, is another great example of a company that targets health in a totally new meaningful way.
Caresource takes a bold approach to care by helping patients find jobs as opposed to lecturing them about health, while Zensource helps patients by bringing emotional support to palliative care and enhancing a patient’s dying days.
The bottom line is that if it is health we seek, we need to understand how people and communities define it. Spending on healthcare services alone, is akin to attempt to improve the nation’s cars by investing in mechanics rather than new factories.
Most governmental and big private healthcare behemoths are invested in doing things the same way and resisting the entrepreneurial change of community-driven, socially-minded healthcare. If this were the car manufacturing industry, wouldn’t they have all been fired by now?
Isn’t it ironic how we care about the health of our cars and environment much more than our own bodies?
 J. Michael McGinnis, Pamela Williams-Russo and James R. Knickman The Case For More Active Policy Attention To Health Promotion Health Affairs, 21, no.2 (2002):78-93