ViewPoint: Health policy should focus on keeping people, communities healthy

February 6, 2015
By David Martin
Boston Business Journal

In 1965 Dr. Jack Geiger founded a community health center in an impoverished area of Mississippi.  Many of the children who came to him for medical care were malnourished and he begin writing them prescriptions for food.  Some government official was dispatched to tell him that prescribing food was not covered under their health insurance program and he responded, “The last time I looked in my textbooks,” he said, “the specific therapy for malnutrition was food.”

What Dr. Geiger was telling us back then is an essential point about health care that we have yet to make part of the conversation about health care reform—health care should be about actual health.  The goal of medicine is a healthy person and our health care system should be designed to produce healthy people and healthy communities.  To do that, we must direct resources in ways that create healthy communities.

The tragedy of our current system, despite all our reforms, is that it still revolves around treating patients after they have become sick and does little to address the systemic causes of illness and disease.  One reason for this is that keeping people healthy is not nearly as lucrative as treating them once they are sick.  But another reason is that people just don’t know that a much better system is possible.  When Dr. Geiger wrote his young patients’ prescriptions for food he was pushing the boundaries of what we think of as practicing medicine, and perhaps now we are ready to embrace that vision of medicine.

At both the state and federal level we have been trying to reform health care for over a decade.  And we’ve had some success in reducing the number of uninsured and some promising signs of reduced health care spending.  But either of these achievements could backslide unless we change the way we think about health care.  That is, to see it as Dr. Geiger did—doctors and nurses advocating for the health of their patients and the health of the communities they live in.

Getting people to think about prescribing food as practicing medicine may seem far-fetched, but a few programs operating in Massachusetts now are pointing the way to innovative ways of practicing healthcare.

Boston Children’s Hospital created a program to treat children who suffer severe asthma attacks with a community health worker who visits the child’s home and helps the parents identify issues there that may be causing the attacks.  Under the program, doctors can even recommend (prescribe?) a vacuum cleaner to help reduce dust and other irritants that cause attacks.

Similarly, Commonwealth Care Alliance has a program called Community Paramedicine that sends paramedics to the home to treat minor injuries or problems and spares the patient a trip to the emergency department.

Prescribing a vacuum to treat asthma and sending paramedics to treat patients in their home are small steps toward realizing that once we stop thinking of health care as a transaction between a buyer and a seller and instead think of it as a social enterprise where health care providers advocate for the health of their communities, then health care becomes something more than expenditures for tests, treatments and procedures.  Our health care resources can be reallocated to things that the community needs to live health, fruitful lives.

Health care spending in the U.S. is monstrously wasteful, inefficient and in many cases unhelpful to the patient.  Estimates are that up to 30% of our health care expenditures is wasteful.  Rooting out the waste and overtreatment in health care will be difficult, but if people know that the money being wasted on things they don’t need, and that don’t make them healthier, could be spent on things that actually improve their lives, they will start to see what Dr. Geiger envisioned 50 years ago: a health care system that offers real health.

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