There's a crisis in American healthcare that goes far beyond the debate over healthcare finance reform or the implementation of the Affordable Care Act.
If money could solve today's most pressing medical problems, the United States - which spends more than any other country on healthcare - would have the best health outcomes in the world. Despite all that we spend (nearly $3 trillion in 2011), growth in life expectancy in the US has slowed compared to other economically developed countries, trailing nations like Slovenia and Denmark, which spend substantially less than the US on healthcare.
The crisis in American healthcare today is the ascendance of chronic conditions, which can't be fixed with a pill or procedure. We are seeing a transition from predominantly biological, physiological, and microbial origins of disease to diseases caused by social and environmental conditions. As a result, clinicians can invest hours of treatment and test a variety of different pharmacological combinations with limited, if any, change in outcomes.
The simple truth is that our traditional model of healthcare delivery doesn't work anymore. It was designed to respond to acute illnesses like polio and typhoid, not to address causes of disease that occur far beyond the clinic walls. No amount of healthcare reform focusing on healthcare financing and organizational inefficiencies can fix the root problem in our medical system.
We Need a Medical Cultural Revolution
There is growing recognition that individual health is nearly inseparable from community health. We need a transformation of American healthcare that recognizes this reality and works to align clinical medicine and public health as partners in a collaborative effort to improve population health.
In the past, many of our triumphs over disease - for example, polio, smallpox, and malaria - have been the result of medical breakthroughs providing clinicians with a new drug to eradicate an illness. As we look at our current healthcare challenges, laboratories no longer offer the possibility for a magic bullet.
There is no treatment, pill, or vaccine to address the lack of fresh fruits and vegetables to support a healthy diet, limited options for physical activity, exposures to environmental toxins, or the disproportionate distribution of alcohol and tobacco advertising and outlets. These are the community-level drivers of the chronic diseases that plague population health and are responsible for much of the healthcare spending in the US.
Health care reforms, including the Patient Accountability and Affordable Care Act, focus on needed changes to healthcare financing and reimbursement as well as increased access to healthcare. These are worthwhile goals, but they will not lead to the transformation needed in American health. Integrating the efforts of public health and clinical medicine will allow us to make the next vital transformation in healthcare to ensure that we have a system that acts upon the undeniable link between the individual and the community.