The Question No One Asks About Healthcare

The query gripping the nation: "How do we reform health care?"

But I don't hear anyone asking a far more essential question: "What is health?"

Given that we all want health and spend trillions to "care" for it, it's sobering how little thought we give to its true meaning. When I ask, the response I receive is typically "the absence of disease." Health is much more interesting and consequential than this. To define it in this negative sense is no more accurate than to define wealth as the absence of poverty.

I define health as a positive state of wholeness and balance in which an organism functions efficiently and interacts smoothly with its environment. Good health comes from an innate resilience that allows you to move through life without suffering harm from toxins, germs, allergens and changing environmental and dietary conditions.

By no stretch of the imagination does mainstream American "health care" move us closer to this vision of robust, resilient health. It is a fiscally unsustainable, technology-centric, symptom-focused disease-management system. Consider that two-thirds of all Americans die from cardiovascular disease, cancer, and diabetes, which are all strongly associated with lifestyle choices. Maintaining and paying for our current system will serve only to continue - if not exacerbate - this trend, and bankrupt the nation in the process.

A truly reformed health care system will care for our health rather than care for our ills. This does not mean it will abandon those who are sick or injured. Instead, measures that maximize our innate self-healing capacity - our health - will be used first whenever possible to both facilitate recovery and keep us whole and balanced.

How do we get there? Here is a summary of the health-promoting, disease-preventing agenda that I set forth in my new book, Why Our Health Matters: A Vision of Medicine That Can Transform Our Future available September 8, 2009.

• Our medical schools must teach health promotion along with disease management and crisis intervention. If the National Board of Medical Examiners included questions on these subjects in required student exams, schools would quickly add them to their curricula.
• Insurance companies, whether private or government owned, must be compelled to pay for health-promoting measures. In turn, this will encourage physicians to offer such treatments in earnest.
• The federal government must create new departments within the National Institutes of Health and the Department of Health and Human Services to emphasize health promotion and disease prevention. An Office of Health Education should be set up within the Department of Education to establish a K-12 curriculum of health, healing and disease prevention.
• Citizens must pressure the American Hospital Association, the American Public Health Association, the Centers for Disease Control and other relevant governmental agencies to make greening our hospitals and medical centers a top priority so that they themselves don't create even more illness. Examples of such changes: stopping environmental pollution caused by hospitals (e.g. mercury discharge) and banning the sale of junk food on their premises.
• We need to accept the seemingly obvious fact that a toxic environment can make people sick and that no amount of medical intervention can protect us. The health care community must become a powerful political lobby for environmental policy and legislation.
• We need to support grassroots movements to ban sales of soft drinks and junk foods in public schools, make schools serious about physical education and health education, and fight attempts by agribusiness to weaken federal organic standards.
• We must insist (with the power of our pocketbooks, voices and written words) that television networks, movie studios, radio, the internet and print use their tremendous influence in a positive way. The media showers us with destructive, illness-promoting messages (such as kids devouring junk food and adults popping pills for trivial, transient discomforts) and fear-based news reporting on health. We must use creative messages in the media to counteract this influence.
• American businesses are struggling to pay outrageous, exploitive insurance bills for their employees, hampering our ability to compete globally. In 2005, General Motors paid an estimated $1,525 in health-care costs for each car it made; Japan's Honda paid $97ⁱ. We must convince corporate America that preventable employee absenteeism and diminished productivity can be counteracted in a cost-effective way by offering workers health-promoting programs such as discounted gym memberships, smoking cessation programs, and more nutritious cafeteria food. Ultimately, the sophisticated American marketing talent that pushed us toward unhealthy behaviors might be marshaled to move us all in directions that are more consistent with good health.

Benjamin Franklin's adage "An ounce of prevention is worth a pound of cure" has never been more relevant. In Franklin's time, contagious disease was the scourge of humankind, but focused effort has rendered it a historic footnote. With sufficient will, we can do the same with chronic disease that now costs us so much to manage.


References:

ⁱRelman, Arnold S., M.D. A Second Opinion: Rescuing America's Health Care. Public Affairs, 2007, p. 78

Andrew Weil, M.D., is the founder and director of the Arizona Center for Integrative Medicine and the editorial director of www.DrWeil.com. Become a fan on Facebook.

Follow Dr. Andrew Weil on Twitter: www.twitter.com/DrWeil

Comments

[DrCharlesMartin]

Some excellent comments. Thank you for pointing out that the lifestyle related chronic diseases are now our primary contributors to premature death resulting in years of productive life lost. One of these, type 2 diabetes, is now an epidemic. Yet there is little evidence of a comprehensive approach to slowing this rising tide.

We write extensively about related issues at http://dentistryfordiabetics.com/blog, especially the links between elevated blood sugar and gum disease that can interfere with diabetes control and significantly increase risk of serious health events such as heart attack, stroke and blindness.

- Charles Martin, DDS
Founder, Dentistry For Diabetics

[balancedsolution]

REMEMBER - Your Doctor is a businessman who makes money on helping you through your misery.

Businessmen can corrupt easily due to $$ issues.

just beware out there.

[balancedsolution]

Wake UP!

Western Medicine is a band-aid at best. Where has the true innovation gone? Where are the cures?

What company wants a cure when you can profit off a "disease management plan."

Do your best to exercise, eat healthy, and remain at a low stress level.

Keep your body in an alkaline state.

Lay off the sugar and fast food.

The last person i want to see is a doctor, because they sometimes create more issues than were there before.

ALSO **** Have Doctors Post PRices Above The RECEPTION DESK, that way you can PRICE SHOP THEM. Never understood how doctors can do as they feel in the exam room...than bill your insurance.

Take a stand and ask if this test, or that test is truly necessary. Sometimes it is, but sometimes it isn't. It's up to you to stamp out the corruption.

Lipstick on a Pig when a doctor keeps asking you to come back for visit after visit.

I love doctors because for the most part they mean well. It's the doctors that are bought by insurance companies i don't trust.

Make sure your doctor has your interest at heart, not your insurance companies. You can tell by doing research on the most effective drugs, treatments, etc. Ask around. Do your work. It's your life.

[Lorianne]

The Health of Nations
http://www.washingtonmonthly.com/features/2003/0304.longman.html

To get an idea of how wildly ineffective our health-care system is, consider this: The United States spends roughly $4,500 per person on health care each year. Costa Rica spends just $273. That small Central American country also has half as many doctors per capita as the United States. Yet the life expectancy of the average Costa Rican is virtually the same as the average American's: 76.1 years.

How can that be? According to public health researchers, the biggest reasons are behavior and environment. Costa Ricans consume about half as many cigarettes per person as we do. Not surprisingly, they are four times less likely to die of lung cancer. The car ownership rate in Costa Rica is a fraction of what it is in the United States. That not only means that fewer Costa Ricans die in auto accidents, but that they do a lot more walking, and hence they get more exercise. Thanks to a much lower McDonald's­-to-citize­n ratio, the average Costa Rican thrives on a traditional diet of rice, beans, fruits, vegetables, and a moderate amount of fried food--and therefore enjoys one of the world's lowest rates of heart disease and other stress-related illnesses.

[KristinNoelle]

The spending is actually even higher now. The 2009 WHO report stated that the US spent almost 7,000 per capita in 2006. With the annual increases it is probably somewhere in the neighborhood of 7500-8000 today. Some of this could be attributed to the aging baby boomers, but it is still obvious that the rate of spending is far outpacing the rate of our population aging.

[Lorianne]

Humana profit up, helped by Medicare; shares rise
http://www.reuters.com/article/hotStocksNews/idUSTRE5724Z920090803

[xlr8now]

When I was 21 years old, I asked my doctor "what can I do to stay healthy and avoid a heart attack, stroke, diabetes, and cancer?" His answer was, "I have no idea, but if you get sick, then I can help you".

I decided right away that I needed a different doctor, and a different outlook. It took many years of looking, but happily, I am 61 years young, no medical conditions, very active and in shape. I don't ever get a cold, flu, headaches or any other bother. I can walk 18 holes of golf and be ready for more, when guys half my age have to stop 'cause they just can't go on. I have followed Dr. Weil's advice, and others like him, and am happy I did so.

[OceanofChange]

I just read that the same companies that own big agri companies also own pharmaceutical companies. Is that true? So I guess if the food we buy from them makes us ill then they can sell us a pill to make us feel better? Now that would be a very profitable business plan if that were true. Make mine NON GMO.

[Grandmare]

Dr. Weil,

You are the Medical Poet Laureate, as far as I'm concerned.

Thank you,
Para vida y amor sin miedo

Maria Thysell

[creolechild]

If you are concerned about receiving "real" health care reform in this country, please take the time to watch a video on our current system. The video was created by Oregon physicians who are advocating for the single-payer option. The video is very informative and helped me to gain a better understanding of various aspect of health care, as we know now it.

https://www.madashelldoctorstour.com/Mad_as_Hell_Video.html

These Oregon physicians are in the process of organizing a caravan designed to inform the public about the benefits of the single-payer option. At last count they will be stopping in approximately 23 states, on their way to demonstrate in Washington. They need volunteers and our support. Please spread the word.

[iamright2]

Please post about "profits" of non profit hospitals. I have observed the four star hotels that are replacing hospitals. What are the construction costs for the new flat screen tv medical center rooms under construction and renovation? How many dollars are being spent on new construction versus indigent patients?

[Lorianne]

Humana profit up, helped by Medicare; shares rise
http://www.reuters.com/article/hotStocksNews/idUSTRE5724Z920090803

[Colorado Bobby]

Dr. Weil, thank you for a well thought out approach to what we need.
I agree that diet and choices (smoking, alcohol, drugs) are also a critical part of this equation. Personally I think that to avoid the "Crazies" screaming for their "rights" we should increase education about tobacco, and soft drinks, while also taxing them highly. The addition of "High Fructose Corn Syrup" to just about everything sold in stores is also something the FDA needs to look at since that agency is charged with providing safe foodstuffs to the American citizenry. Websites such as the HFCC industry mouthpiece at http://www.sweetsurprise.com/ would have us think that HFCC is one of the "Basic Food Groups" of required things we should eat. Read the stuff they say on that site. It's spin at its sugary sickly sweetest absolute best.
Bob

[Toxess]

Preventative measures such as maintaining fitness and good nutrition are excellent recommendations, but not everything can be prevented. While a lot of money could be saved by encouraging people to live healthy lifestyles, let us not delude ourselves that it is a panacea. Take heart disease as an example: the single most important thing you can do to avoid a heart attack is to choose your parents carefully. Yes, the heritability of heart disease is such that even if you eat right and follow an excellent exercise regimen, if heart disease is in your genes, you are at risk of heart disease.

[billw8017]

I do appreciate that public sanitation and public health as by food inspection (restaurants, groceries, milk and meats, all that stuff) were introduced and improved with the discovery of germ theory late in the 19th century and may have, more than anything else, extended our lives. At that, I have to remember an article in a recent Economist (the English ooze scorn for American medical coverage) about a small program of the University of Kentucky that arranged to have set the broken bone of an uninsured steel worker. The Kentucky program is being defunded as the state cuts back in this recession.

Setting bones is a well known medical practice. Anthropologists find evidence of the practice among the Mayan elite. It is the difference between serious disabling and complete recovery. It is possible to live in the United States and not be covered for this ancient procedure.

Covering essential medical practices, assuring doctors of their proper recompense, spending the little difference between an able citizen and a social dependent -- is more than simple decency. It is responsible and patriotic and, in every way, the right thing to do. Don't try to do it with charity and voluntarism: such things should be conventional and certain.

When such simple things are done, we can and should worry about training doctors in more sophisticated practices.

[1tourist]

You are right on in your analysis- but consider the injustice of the hard working stiff who has a heart attack and pays with the house that he worked all of his life to buy, while the guy on public assistance, who never worked for anything, with the same malady, lies next to him, getting the same care and paying nothing- universal-single payer is the only way to go- and justice for all.

[billw8017]

I think we agree, but your little rip on charity care seems gratuitous. Perhaps you want to say that means testing for benefits can be arbitrary and unpopular? I certainly agree with that !

[CigarStoreIndian]

Good article! The current health care reform bills in the house and senate have left out two of Healthcare's stakeholders, trial lawyers and consumers. The majority of healthcare dollars spent in this country goes to treating conditions that result directly or indirectly from lifestyle choices. We eat and drink too much of the wrong things. The current healthcare bills tell the overweight, chain smoking, fast food eating person with high blood pressure that they can get the same benefits at the same cost as the next person who leads a healthy life.

[billw8017]

One thing to remember about fast food is that it is not altogether without nutrition. Such foods mostly fail because they are limited, they meet essential needs early, then most practically offer calories. A limited menu is simply a practical way to run a fast food stand. More formal low cost restaurants may exploit cheap methods of food preservation (freezing, canning, precooked portions) that deplete nutrition. Never altogether without essential fats and starches and some nutrition, they sustain life without fully enhancing life. Perhaps, people should eat more and leaner sausages rather than steak or hamburger, more salads rather than French fries and ketchup, more actual food.

Oddly enough, even better than an improved drive thru is getting out of the car and walking to a sandwich shop. I can imagine such might even be an elegant lifestyle, but I wouldn't know.

[BlueTidalWave]

"The current healthcare bills tell the overweight, chain smoking, fast food eating person with high blood pressure that they can get the same benefits at the same cost as the next person who leads a healthy life."

Um, why shouldn't they get the same benefits? Are you really saying that in order to have health care (that each person pays premiums, deductibles and co-pays for) that one should be required to live a 'perfect' or societally-approved lifestyle?

Should someone who works in a factory have to pay more than a person who works in an office? Should someone who engages in risky behaviours like skydiving also have to pay more? Who decides what the 'approved' diet and lifestyle consist of?

[CigarStoreIndian]

They should get the same benefits. But there should be something to incourage people to change behavior they have control over. I'm not suggesting someone with cancer or MS be charged more. I'm suggesting that someone with dangerously high blood pressure who refuses to try and control their blood pressure through diet, exercise and/or medication should pay more. They are making a conscious decision to live an at risk unhealthy life. Same for the skydiver

[jim51fla]

Absolutely! Anyone who exhibits a riskier health life-style SHOULD definitely pay more! Should newly-licensed teenagers pay the same for car insurance than an experienced driver? It is not a hardship to eat healthy and keep active, if fact, it's FUN! Not to mention the savings! Our society has to learn that a Happy Meal at McD's is neither happy, nor a meal.

[1tourist]

So put taxes on that unhealthy stuff, to pay the universal health insurance premium, or is this just to sensible?

[dewicymro]

I have some experience of working with American doctors in UK hospitals

The USA has the highest expenditure per capita on health care in the world. BUT you don’t get value for money! Some disturbing statistics support this opinion.

Infant mortality (Deaths of children under 1 year old)

1st Iceland 2.9 deaths per 1000 live births.
22nd UK 4.8 deaths per 1000 births
33rd USA 6.3 deaths per 1000 births

Overall life expectancy

1st Macao 84.36 years at birth currently
6th Canada 81.86 years
25th UK 79.01 years
35th USA 78.11 years

When American doctors first start work in UK hospitals, it is obvious that their whole emphasis is on defensive medicine. They invariably over-investigate and over treat patients. Nothing comes without side-effects; Excessive X-Ray or CAT scan investigations leave the patient vulnerable to malignant problems later in life...leukaemias and the like. All drugs have side-effects; the more you use, the more side-effects you get. Minor illnesses get major therapies which do very little and carry big side-effects. This is poor medical treatment and costly.

I am surprised to read that medical training ignores preventative health in the USA. That's a huge mistake that carries enormous costs in later life. I trained as a doctor some 30 years ago and preventative medicine was an important part of my training. Stopping the junk food, pill popping, overeating attitudes in a society pays great dividends in later life.

[KristinNoelle]

US medical schools don't exactly ignore preventative health; however, the manner in which it is practiced leaves much to be desired. Ideally, all health professionals and policy makers would work to ensure people are educated about the importance of eating well, exercising, and the like; however, these efforts are largely postponed until patients actually have an illness or disease. Unfortunately, by this time most patients are set in their ways and find it difficult to change their habits and improve their health.

I don't blame doctors for the lack of attention to prevention; the problem is the health system itself. Providing preventive care unfortunately doesn't bring in much money for health insurance companies, nor is it likely to save them much money in the future. Prevention of many common diseases must start extremely early, perhaps even in childhood, to be effective. But the chance of a child retaining the same health insurance throughout life is highly unlikely. HMOs would be foolish to spend a lot of money on prevention because they wouldn't reap the rewards; the individual's insurance company 30 years in the future or Medicare would.

Mostly, I'm in favor of private enterprise, but in the case of primary health care it has become blatantly obvious that it just isn't working. I'm not saying the government should take over, but they do need to create incentives for insurance companies so that providing preventative care isn't the equivalent of throwing money away.

[1tourist]

Medical doctors do not have such a good life expectancy either