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America’s Health Care Emergency

By Sarah Moore on February 8th, 2019

Last week, our team spent three inspiring days immersed in compassionate integrity training. In addition to developing skills for compassion toward ourselves and others, this training was unique in its culminating focus on compassionate systems. A compassionate system is one that causes the least harm and enables the greatest wellbeing for people.

Of particular concern is the United States’ health system. It’s a massive one that, according to the World Health Organization (WHO), consumes 18% of our economy1—the highest in the world. Yet all too often it fails to be an effective, much less compassionate, system. In 2000, WHO ranked the United States 37th in overall performance and 72nd by overall level of health compared to 191 other nations.2

And we already know what we’re doing wrong.

Only 20% of health outcomes are tied to clinical care. The other 80% are determined by the physical environment, health behaviors like diet and exercise, and social determinants like education, income, and social support, among others. Ample evidence points to policy, systems, and built environment changes that would improve population health outcomes.

Yet we don’t come close to allocating 80% of our nation’s healthcare spending to research social determinants of health, chronic disease prevention, and evidence-based change. Instead, we throw good dollars after bad to support an inefficient and ineffective clinical care system that has a smaller impact on people’s health. It’s like spending nearly all of your budget to remodel every room in your house when you know the foundation is unstable.

Why isn’t this approach to health treated like an emergency?

Why isn’t it considered an urgent problem that our health system pours so many resources into treating one symptom at a time rather than identifying and addressing the root causes of poor health outcomes for entire communities of people?

Why do so many communities still have zoning codes that make it hard to find affordable homes close to high-quality job opportunities and affordable, reliable public transportation that connects the two? Why are traffic fatalities—more than a passenger jet full of people every day3—not treated with the same urgency as an airline crash to improve safety? Why is it easier and cheaper to buy junk food than a nutritious meal?

Increasingly, healthcare providers are also asking these questions, and some are implementing programs that address social determinants of health. However, as a recent post in Health Affairs outlines, those ideas “aren’t about improving the underlying social and economic conditions in communities to foster improved health for all—they’re about mediating patients’ individual social needs... in ways that may impede efforts to address those conditions that impact the overall health of our country.”

A number of organizations have been addressing this disconnect in a different way by exploring how public health practitioners and clinical care providers can partner to better align the health system with communities’ full spectrum of health needs.  

Creating Effective Hospital-Community Partnerships to Build a Culture of Health is a report that outlines how hospitals and communities can develop and sustain partnerships. The Health Research & Educational Trust (HRET), with support from the Robert Wood Johnson Foundation, conducted 50 interviews with hospital, health system, and community leaders from 25 diverse communities. These interviews generated lessons learned and best practices for identifying community health needs, potential partners, and sustainable partnership structures.

The Network for Regional Healthcare Improvement (NRHI) represents more than 30 regional health improvement collaboratives (RHICs), along with state and national partners, working to transform health care delivery, payment, and information systems to reflect local experience. Its current priorities include increasing transparency and access to data, as well as coordinating federal programs to best reflect and leverage local innovation.

ReThink Health Ventures is working to show how multi-sector partnerships can accelerate change and transform health, and that “an integrated, dynamic, and high-functioning health ecosystem is possible.” The project outlines what stalls progress and drives momentum with observations from working with communities on the ground and a group of advisors (including Natalie S. Burke, President and CEO of CommonHealth ACTION, whose wisdom we shared in a previous post).

The Centers for Disease Control and Prevention developed several resources and tools to help further catalyze health system transformation. And as far back as 2015, the Robert Wood Johnson Foundation’s blog shared “The Secret to Successful Health Partnerships,” writing “Improving access to outpatient and inpatient medical services and the quality of those services, while vitally important, are not enough. To effectively design, implement, and sustain a comprehensive approach to promoting the overall health of communities, we need meaningful collaboration among healthcare delivery organizations, governmental public health departments, and other community stakeholders.”

Two final questions:

When you examine your work to improve community health, what’s one goal you know isn’t ambitious or urgent enough? What would you change if you could? Go work for that change like millions of lives depend on it. They do.

Want to share your thoughts on this topic? Tweet us at @HPlacesbyDesign.



1. Health Affairs:
2. The World Health Report 2000:
3. National Highway Transportation Safety Administration: "FARS 2010"
4. Graphic: A Public Health Framework for Reducing Health Inequities, Bay Area Regional Health Inequities Initiative

Sarah Moore


Artist and advocate for natural places.