Radical Healing: What’s Ailing our Healthcare System and How to Move Towards Recovery
Sonia Sarkar, NLC Boston
The desire for health is at once universal and deeply personal. On the one hand, we all grapple with the uncertainties and reassurances that come with trying to navigate our way to physical, mental, and spiritual well-being — as patients and caregivers, consumers and residents. On the other hand — despite this shared understanding — our perspectives on who deserves health, how we deliver it, and how it gets paid for are wildly divided, shaped by our individual experiences and understanding of the American social contract.
Maybe this cognitive dissonance isn’t that surprising. Health and healthcare, after all, are tied to those most basic of human needs and emotions: our mortality, our relationships with our loved ones, our right to lead a full and flourishing life. We have tried, to the extent we can, to make sense of what takes place within our bodies and minds — to understand them through the lenses of science, professionalism, and technology — but the truth is that so much of what drives health feels beyond our control. And as a result, it’s really hard to build a system around it.
Think about your own interactions with our current healthcare system — whether you’re rushing to the emergency room, deciphering annual lab results, facing down an insurance bill, or realizing that all of the available choices for a family member’s treatment are terrifying ones. None of these situations are easy or rational, nor do they take place in the form of a simple transaction — like the experience of shopping for a pair of socks, for example. And yet, in the United States, we predominantly talk about healthcare as a product, something that can be easily broken down into units and costs.
So it’s against this backdrop that we arrive at today, with our nation’s decades-long debate over healthcare raging — single-payer v. market; Medicaid v. no Medicaid; universal human right v. big business.
But as our policymakers and stakeholders on all sides go back and forth on how to restructure our existing healthcare, they frequently miss a key point: achieving health is an entirely different endeavor altogether.
Our existing healthcare system is primarily focused on making you better after you get sick — not treating the root causes of what made you sick in the first place. This is despite the fact that — according to a report from the Kaiser Family Foundation — just 10 percent of our health is determined by the care we receive within a clinic’s walls. The other 90 percent can be attributed to where we live, how we work, and what resources our communities have access to: not coincidentally, issues that are directly related to representation and power.
Take, for example, a patient who has been told to eat healthier and get more exercise. As anyone who’s ever tried to do both of those things knows, that’s challenging enough even when all of the stars align. But what if that patient lives in an urban food swamp dense with fast foods, or a rural food desert and can’t find fresh, nutritious foods for themselves and their family? What if redlining and other racist policies have led to economic disinvestment in that patient’s community, stripping it of parks and trails and replacing them with crumbling sidewalks and an unsafe built environment? What if that patient is a recent immigrant who saw the doctor because of a health crisis but refuses to go back for their follow-up visit for fear of ICE apprehension?
In each of these cases, it is the social, economic, and political determinants of health — things like poverty, discrimination, access to housing and employment — that ultimately shape a person’s potential for and attainment of health.
Over the course of my career, I’ve seen these forces up close: as a public health undergraduate at Johns Hopkins, it boggled my mind that despite proximity to one of the leading healthcare institutions in the world, patients in some Baltimore neighborhoods face lower life expectancies than in Rwanda or Nepal. Later, as a student advocate with Health Leads Baltimore, patients told me their experiences with a medical care system that disregards community members as experts in their own health, labeling them “noncompliant” or merely viewing them as research subjects. And later, as Chief Policy and Engagement Officer for the Baltimore City Health Department, I heard directly from residents in forum after forum that there is a clear line between health inequity and the economic disenfranchisement of their communities, along with the violence and trauma that comes with it.
In this 12-part series, we’ll explore this fundamental tension between our status quo healthcare system and achieving actual health — sorting through the ideologies, policies, and movements that shape it all.
First, we’ll take a look at how we got here. What were the forces that came together to give us our current medically-focused health system, and why should we care that it doesn’t yield the positive health outcomes that we would expect given our outsized healthcare spending?
Second, we’ll consider where we’re headed. What issues do the existing healthcare reform and policy discussions touch on — and what do they miss? How do we understand health through the lens of its various component actors — government, civic sector, private institutions, and patients/communities themselves?
Lastly, we’ll think about where we could be, as a nation and a people. What space does health occupy in our collective national conscience, and how are people mobilizing around a new vision? What would it look like to not only build a healthcare system that supports health — but also to think about radical new forms of democratic ownership and governance for that system?
As we gear up for the 2018 midterm elections and beyond, healthcare continues to rank amongst the top issues that voters are concerned about. And this isn’t just about hashing out prescription drug benefits or determining whether insurance premiums will continue to rise, even though those issues are both extremely important on a personal and societal level.
Rather, we can see this conversation on health — as we see so many of our conversations these days — as a referendum on how we relate to one another as people.
As “social determinants of health” move from a nice-to-have to a major buzzword, we see how quickly they can be co-opted. For example, the Centers for Medicaid and Medicare Services claims that Medicaid work requirements are an example of upholding the relationship between employment and health — when in fact this directly counters prevailing evidence showing that access to healthcare is essential to maintaining stable employment, and stable employment in turn enables health (to say nothing of the fact that we can support employment via investing in and guaranteeing jobs, rather than punishing those who currently don’t have them). As has been the case across our country’s short history, the parsing of which groups of people deserve what is directly foundational to our understanding of health.
Next month, we’ll take a look at how we ended up with a healthcare system that is so lopsidedly oriented towards medical treatment rather than prevention and well-being.
Looking forward to the conversation!
Sonia Sarkar is the Former Chief Policy and Engagement Officer for the Baltimore City Health Department, and previously served as Chief of Staff and Special Advisor at Health Leads, a social enterprise focused on essential needs for health, such as food and housing. Currently, she is a Robert Wood Johnson Foundation Culture of Health Leader, a Health Policy Fellow at New America, and a Center for a Livable Future-Lerner Fellow at the Johns Hopkins School of Public Health.