In debate, talk health, not just health care

As Houston prepares to host Thursday’s Democratic presidential debate, we can expect to hear more about health care and the candidates’ ideas to improve our health care system. It’s not surprising considering a plurality of voters see health care as the most important issue facing the nation. But I’m hoping we will also hear about how to actually improve Americans’ overall health. It’s not enough to talk about the health care system without a focus on improving health.

Despite spending more on health care each year, Americans aren’t getting healthier. In fact, the U.S. ranks below other developed nations on measures such as life expectancy, infant mortality, and access to primary care. We know the cycle is unsustainable, yet we fixate on managing the symptoms — health care — instead of focusing on the root causes that can deliver better health. There’s good news: agrowing body of research shows that by focusing efforts on the non-medical drivers of health, people can get healthier while the health care system saves money. Many chronic health conditions are directly connected to the social, economic and environmental conditions where aperson lives.

Clinical care — arguably one of the largest pieces of health care being discussed on the debate stage thus far — is only 20 percent of what contributes to a person’s health. The remaining 80 percent is determined by those non-medical social and economic factors like housing, neighborhood safety, family support, access to healthy foods, and income. What good does it do to treat people with medical care, if they’re sent right back to conditions that make them sick?

Take Angel, a 14-year-old boy in northwest Houston who loved to play soccer but suffered from severe asthma attacks. The key to better health for Angel wasn’t a new clinic, more insurance coverage, or the latest medical treatment following his next asthma attack. Instead, it was understanding the conditions that trigger his asthma attacks so they can be prevented. By replacing carpets, improving ventilation and removing household mold in his Greenspoint-area apartment, Angel was able to reduce his asthma attacks and enjoy more time on the field. His asthma was managed by a one-time, low-cost, home improvement that health insurance and government programs typically don’t pay for.

Better health doesn’t come from home visit programs alone. A Texas study looking at the relationship between county public spending and health found that shifting current funds to public services such as public health, fire and ambulance, housing development, and libraries was associated with improvements in a county’s health ranking.

It’s also encouraging that private insurance companies and government agencies are also beginning to recognize the role non-medical factors play in being healthy. Recently, Medicaid officials approved North Carolina’s $650 million Healthy Opportunities plan to launch pilot projects that address transportation, access to food, and housing. Projects include home remediation programs for asthma patients and meal delivery services for those with diabetes. The plan allows North Carolina to use Medicaid to pay for non-medical interventions that target the social determinants of health. Nevertheless, there remains no systematic way to pay for evidence-based solutions that target non-medical, primary causes of health challenges.

Organizations such as ours, the Episcopal Health Foundation in Houston, invest in community-based programs that address the root causes of poor health. The greatest reward is seeing our grantees that work within the health care system deliver better health and lower costs with solutions that go beyond the exam room. But what’s still needed is leadership from policymakers to shift health care resources to tackle underlying, non-medical conditions linked to poor health.

As the presidential candidates present their platforms, their health policy debate plays an important role in setting the agenda for the next four years and beyond. Now is the time to change the conversation to improving health, not just health care.

Marks is CEO of Episcopal Health Foundation in Houston.