The ACA Hangs In The Balance — All The More Reason To Stop Getting Sick

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People began asking my opinion about the Affordable Care Act long before it was signed into law. With the future of that law now hanging in the balance, the questions have only intensified.

My answer is always the same: We have to double-down on our efforts to avoid getting sick altogether. This will require the incredible courage to create whole new approaches for overcoming disease.

Population Health scientists have this courage. They’re exploring a broad spectrum of social, environmental, and other factors that are largely new to the biomedical research mix. And they’re finding that these factors can have a profound impact on human health.

Among the growing number of Population Health discoveries, two new papers from Stanford Medicine’s Mark Cullen have shown that where you were born can have a lifelong effect on your health — and that a big reason women outlive men is because they’re better equipped to handle adversity.

The first study found that state-of-residence in early life was associated with overall health status — even decades later, after adjusting for wages, employment status, and state-of-residence as an adult. The study demonstrated that so-called “sensitive periods” in early life have an enduring effect on your chances of developing hypertension, diabetes, and heart disease. When it comes to our health, in other words, what’s past is often prologue.

The second study explored why women consistently outlive men in developed countries. Looking at mortality data for 187 countries over the past five decades, Dr. Cullen found that women consistently exhibit a greater survival “resilience” to social and environmental adversity. This gives credence to a type of socio-biologic explanation: Women live longer because they’re hard-wired for social behaviors, like nesting and family protection, that promote survival.

With Population Health, we can ask — and answer — these and other complicated questions about cause-and-effect among all the determinants of health…

With Population Health, we can ask — and answer — these and other complicated questions about cause-and-effect among all the determinants of health, such as: How does social status affect behavior, and how does behavior affect medical care? How does the environment affect genes? And how have social and genetic factors combined to boost (or slash) longevity?

Once we truly understand what makes some people healthier than others, we can improve the health of everyone — reducing and, in some cases, eliminating our need to finance medical treatment.

The deep urgency around this issue extends well beyond economics and politics. As long as disease exists, even those who are cured will face some persistent form of hardship. Take cancer survivors, for instance, whose bodies and minds are permanently affected by the very therapies that save their lives. These people may have regained a degree of health, but they’ll never be as well as they were before. And without wellness, people can’t achieve their greatest potential.

It is imperative that we build a world where wellness prevails — where everyone has a chance to not just survive, but flourish.

It is imperative that we build a world where wellness prevails — where everyone has a chance to not just survive, but flourish. New fields like Population Health are bringing this world into increasingly sharp focus, and we must throw the full weight of our support behind them.

At Stanford Medicine, we’ve created Precision Health — a revolutionary approach to understanding and eliminating disease that combines the broadest range of emerging and existing fields, like Population Health, big data and other scientific disciplines, and initiatives that focus on the unique doctor-patient bond.

With Precision Health, we’re developing a predictive, preventive health system focused on health and wellness rather than disease and illness — and we’re leaving no stone unturned. For example, I’m now working with Jane Shaw, Dean for Religious Life at Stanford, to launch a course on the role of empathy in human health.

It all plays into our vision of providing people with decisive treatment if they get sick — yet doing everything we can to keep them well.

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