We can all agree that we have reached a point where the status quo in prevention is not enough. Obesity continues to negatively impact adults’ lives and the lives of future generations. Heart disease continues to affect thousands of Americans and is the leading cause of death for men and women. Disparities in health outcomes by class and race persist, despite advances in technology and even improved access. Whatever we have been doing is simply not enough. Now is the time for truly innovative thinking in prevention.
Despite looming shortages, the United States is fortunate to have an expansive network of physicians, nurses, and other practitioners. Unfortunately, health does not happen in hour-long office visits, let alone in 15-minute office visits. Health happens at home. It happens on the job, in schools, on the playground, and in our neighborhoods. We cannot expect primary care to have an improved impact if we do not improve our efforts. The Patient Protection and Affordable Care Act is a great start, but providing better health care coverage, albeit important, is only a minute piece of the complex puzzle we know as “health.” Individual health is shaped and impacted by a wide variety of factors, including many that we think of as outside the realm of typical primary health care practice. Racism, discrimination, housing quality, neighborhood safety, income, transportation, education and the availability of fresh food – just to name a few – all play a role in our health. These social and economic factors are collectively known as the social determinants of health and impact all people. Disparities arise because some people have more and better resources for coping with the factors that have a negative influence, while others have very few or no resources. (To learn more about the social determinants of health, please visit the links provided below.)
Work has already begun to address many of these factors from both policy and grassroots perspectives. Organizations such as PolicyLink and Prevention Institute have been highly active in getting some of these issues on local, state, and federal policy agendas. The First Lady’s Let’s Move! initiative is a great example of a large-scale, comprehensive effort to bring awareness to the factors that contribute to obesity in children. Let’s Move! not only encourages healthy eating and physical activity, but seeks to improve access to healthy food and empower parents and caregivers to make good nutrition choices for their children. The Let’s Move! website reports that since the initiative launched in February 2010, more physicians and pediatricians have conducted Body Mass Index screenings. Those results are interesting in their own right, but it begs the question what else can primary care providers do to help their patients live the healthiest lives possible.
Some might argue that everyone has a unique role to play in this fight for better health outcomes, that primary care providers do not have control over these external forces, and that it is not right to expect them to engage in something they didn’t sign up for. I agree that it is not reasonable to expect primary care to be able to change the situations their patients encounter outside of the care settign, but I do believe that health care providers have a duty to do as much as possible in the best interest of their patients. Health Leads (formerly Project HEALTH) is an organization that has successfully implemented an innovative model for increasing primary care’s role in addressing the challenges many people face on their journey to health and wellbeing. In the Health Leads model, volunteers fill “prescriptions” that care providers write for resources such as food, housing, job training, and fuel assistance. Patients are connected with resources in their communities to help them protect and improve the health of themselves and their families. Health Leads and many others are working towards a world where disease is not just managed but prevented and where well-being is promoted.
Primary care, with its connection to communities and to individuals, is in prime position to take on an expanded role in the fight for health and we must continue to ask ourselves tough questions. What is primary care’s evolving role in creating and implementing sustainable solutions that help all people achieve and maintain optimal health? How can we better help patients navigate the terrain encountered outside of clinic and office visits? What does disease prevention mean in a social and economic context? I don’t have all of the answers as to how this can happen or what exactly should be done, but I know that it can and that it should.
Resources
WHO: Commission on Social Determinants of Health
http://www.who.int/social_determinants/thecommission/en/
Unnatural Causes
http://www.unnaturalcauses.org/
CDC: Health Disparities and Inequalities Report, 2011
http://www.cdc.gov/mmwr/pdf/other/su6001.pdf
Marmot Review: Fair Society, Healthy Lives
RWJF: A New Way to talk about The Social Determinants of Health
http://www.rwjf.org/vulnerablepopulations/product.jsp?id=66428&cid=xtw_rwjf
PolicyLink
Prevention Institute
http://www.preventioninstitute.org/about-us.html
Health Leads
http://www.healthleadsusa.org/
Determinants of health: the role of the general practitioner?
http://www.primary-care.ch/pdf_d/2009/2009-15/2009-15-249.PDF
