I’m a reductionist at heart so let’s start with a number – 20. This is the percentage that health care contributes to our health, according to Nancy Adler of the University of California, San Francisco. She was writing for ‘Investing in what works for American communities’, a project that calls on leaders from the public, private, and non-profit sectors to build on what we know is working to move the needle on poverty.
It’s worth taking a moment to reflect on that number. It’s small. And yet when you read about health, whether it’s in the mainstream media, academic journals or the effervescent health innovation scene, what you’re really reading about is health care. It’s very rare to read about health creation.
I’m saying this a lot these days and am always countered with the idea of prevention. There are two reasons why I am reserved about prevention.
The second reason why I am reserved about prevention is that it simply does not work – or at least does not work well enough, especially in the communities that need it most. While we know what people need to do to prevent disease we don’t know how to make them do it sustainably (indeed, the very idea of making people do something may be the core of the problem). Consequently what we’re seeing is that prevention – or wellness programmes – are a waste of money; for every $1 invested the return appears to be $0.48, and even that is considered an over-estimate.
So health care and prevention contribute only 20% to our health and the latter doesn’t even work. Now what?
The 80% that contributes to our health comes from our genes, our behaviours, social factors and the environment. We hear a lot about these topics and yet – if you really think about what you’re hearing – it’s largely based on reducing the cost of care. We’re using the value model we’ve developed for health care to assess the worthiness of the 80%. That makes no sense.
Isn’t it time we found a new model or models?
The investor, Esther Dyson, has recently written about this.
Producing health connotes an activity, not a state. You cannot simply avoid disease; you have to do something to promote creation of the desired capacity… Players in the health-production business include not just companies and employers, but also national and local governments, health systems, schools, and buildings. All of them have a long-term interest in the health of the people they serve…
Yet I confess to doubt. Getting the language right is easy compared to actually delivering on the promise.
My view is that the doubt hinges on the fact that we don’t yet have models to value health creation. The most inspiring I have seen to date remains this sketchy video by David Relph, the Head of Strategy and Business Planning at University Hospitals Bristol, in which he suggests using social impact bonds. There’s something deeply authentic about David’s work – it’s scrappy, exploratory, not slick. It feels like the visual manifestation of the uncertainty and ambiguity in which we have to find new forms of health-related value.
Although it may feel overwhelming there are two movements out there that give me hope. The Democracy Collaborative is doing sterling work linking the operations of ‘anchor institutions’ – major local employers – to better outcomes for local communities. They’ve come up with a number of indicators to guide people, all of which are based on analysing case studies. In the US, hospitals are often anchor institutions so it’s an interesting question to ask how they create community value above and beyond dealing with sickness (how many hospitals do you know are asking themselves that question?).
The second movement is collective impact, the idea that a group of actors from different sectors can join forces to solve a complex social problem. In a recent blog a funder of collective impact said:
It’s a testament to the stickiness of the ideas behind collective impact that three years in, many people…remain pretty jazzed about the idea and its possibilities—but also deeply unsure about what exactly it is…
In 2014, Wellthcare will be profiling initiatives that create health – the ‘Wellth Creators’, as we’re set to call them. We’ve had two to date, Jersey Post and GeriJoy. We’ll also be publishing a Manifesto that sets the agenda to experiment in the 80%. To paraphrase Nancy Adler’s writing, it’s too early to provide an explicit formula for how to create health but it’s not too early to start experimenting.
Indeed, it might be getting too late.
This post was first published in MedCrunch.