call her Angie who told me about a
recent health care experience
she said that feeling while so she went
to Urgent Care the nurse told her that
she had a bladder infection and gave her
an antibiotic a prescription for an
antibiotic she said if she took the
antibiotic for five days the infection
would go away but Angie didn’t fill the
prescription she had to spend $10 to buy
diapers for her child
five days later Angie had a horrible
fever and an excruciating pain in her
side she went to the emergency room
where she had to wait for six hours
she even passed out in the waiting room
when she finally got in to see the
doctor they did some tests and they told
her that the infection had gone into her
kidney and was spreading through her
bloodstream the emergency room visit
cost $1,900 and the hospital stay she
had to be in the hospital
in intensive care for two days
and another three days in the hospital
the hospital stay cost her ten thousand
dollars and then she had to spend a
hundred dollars to give to a neighbor to
take care of her young child the the
prescription would have cost
Angie five dollars but instead she was
in debt for $12,000 and then because she
missed five days of work she lost her
job thinking about how to make solutions
for young women like Angie is a big part
of my job as the Dean of the University
of New Mexico college population health
that’s big mouthful so the u.s. spends
three point two trillion dollars a year
on health care that’s with the T
trillion we have pretty bad health
statistics that’s three point two
trillion dollars is more than five times
the budget of the entire US Department
of Defense but these help bad health
statistics for example we are maternal
mortality rate meaning the women who
died in childbirth is going up but for
all other countries it’s going down and
our quality indicators we have the worst
quality indicators of any health system
in the industrialized world only three
percent of the money we spend on health
cares for prevention like smoking
cessation or immunizations or screening
tests we spend about twenty five percent
of our total lifetime health
expenditures in the last six months of
my dad who had heart disease and kidney
failure and diabetes spent the last two
weeks of his life in the hospital the
bill was $100,000 he was a nut cold and
unfriendly environment away from his
friends and most of his family he was
scared and he was in pain and there was
nothing that I could do about it he got
poked and prodded by nurses and every
specialist wanted to do something
different to save him finally he had had
enough and he said to the doctor oh
please I just want to go home to die and
the doctor said Mel if you leave without
our permission Medicare won’t reimburse
us for your stay and your daughters my
sister and I will be left with a huge
and then to make it worse he said to him
but she won’t make it home alive anyway
so instead of being able to give my dad
the send-off that he deserved full of
love and dignity my sister and I are
left with this terrible memory of the
last two weeks of my father’s life our
whole health system is focused on
illness doctors and hospitals only get
paid when their patients are sick we
need to figure out how they can make
money by saving money I think we need to
take the eye out of illness and replace
it with a we for wellness about 80% of
the factors that affect our health come
from our environment our social
situation and our health behavior we
call these social determinants of health
if we really wanted to have a healthy
country we would make sure that
everybody had access to healthy food
lived in safe neighborhoods and had
access to low-cost transportation at
your last medical visit did your doctor
ask you if you shopped in a store that
had fresh fruits and vegetables or how
many times in the last week you ate fast
food in our work in the rural areas of
New Mexico we find that for many people
the only fruits and vegetables they have
come in cans packed in high salt water
or high sugar syrup the least expensive
foods are chips and salsa and those
stores are making a lot of money off of
selling tobacco and alcohol our focus on
illness is costly and often ineffective
my friends the doctors who I work with
say that because we can’t address the
social determinants of health for our
pay
Asians that the patient’s health suffers
and the medical care they give is often
ineffective why do we need the we in
wellness we should make communities the
focus of our health investments we know
why some people have trouble taking care
of themselves
we can identify Geographic pockets of
poor health our communities would
benefit if our health systems were to
repurpose some of their resources to
collaborate to partner with community
organizations can you imagine if our
doctors could give out prescriptions for
housing or transportation or food we
could use innovations to address some of
these problems we can have a less
expensive form of uber to pick people up
and take them to their doctor
appointments or to some place they could
exercise or learn to cook right we could
deliver fresh fruits and vegetables to a
central area in the rural parts of New
Mexico with a drone we do that for
refugees why not our own population
homeless shelters are good for
emergencies but couldn’t we take some of
those unused motels and repurpose them
as apartments for the homeless these
solutions are available so why aren’t we
already using them as a standard of care
for our poorest and our sickest I think
when we change from illness to wellness
our health systems will think of a
different way to provide care that
urgent care clinics will ask people do
you have the money to pay for this
prescription and then they’ll call them
to see if they took their medication
young women like Angie will be able to
take care of themselves and their young
children be able to
keep their jobs and stay out of debt I
think if we can address the social
determinants of health for all of our
populations the US will be a healthier place to live