The Future of Health: Complex, Plural and a Constant Struggle

Pritpal S Tamber, Leigh Carroll and Bridget B. Kelly

June 10, 2014

By accepting that health is socially constructed we need to understand that creating will always be local and fraught

There was a moment, when I was sitting stage-side at TEDMED 2013, when I saw the future of health. It wasn’t bright, it wasn’t full of answers; it was complex, plural and a constant struggle. And yet it was full of collegiality, hope and respect.

Three talks in particular, truly unravelled me. Sally Okun laid bare how clinicians and patients have completely different ways to describe their illnesses, essentially limiting how much we understand of each other. America Bracho shared how she used members of the community to help decide and shape what health messages to deliver with the local Latino community. Lastly, Sue-Desmond Hellman shrugged and said it was patients who’d decide what innovation is and that the medical profession and industry needed to let them in and accept the messiness of the creative process.

As a doctor from an immigrant community, I didn’t need any TEDMED talk to tell me that the medical profession fails to connect with ordinary people, especially those from different backgrounds. However, what these three talks did, was make me wonder whether communities could be a source of health-related value; and if so, given that they’re speaking a different language to the medical profession, perhaps using a medical lens to see their value was part of the problem.

I should state my position here: I don’t believe that health care can meet the growing need for care. It’s not only the wrong shape, but also too personnel-dependent to respond and scale. And yet with ageing populations, the rise of lifestyle-related chronic conditions and more diagnoses as a result of biological discovery, this need is only going to grow. I wanted to understand whether and how communities could meet this need.

I decided to start an ‘exploration’. I called the health-related value in communities ‘wellth’ and named its harnessing ‘wellthcare’. I launched the website, convinced ten thinkers and doers to join me, dubbed the team ‘Wellthcare Explorers,’ and we started debating it through videoconferences.

The debates with the Wellthcare Explorers have been wide-ranging. We’ve touched on patient-defined outcomes, value-based medicine, network models of care, personal and community resilience, social capital, the difference between needs and wants, meaning, fragmenting communities, new communities, transient communities, and the types of assets that sit within communities.

Fascinating though these discussions were, we soon realised that we were locked into thinking about health solely through the lens of health care.

Health care is configured to respond to sickness. It’s actually sickness care. It’s built upon what is called the bio-medical model, which looks at people as individuals and responds when they’re sick. This might have made sense when the main morbidity in the world was down to infections or accidents but it has made less and less sense with the rise of lifestyle-related chronic conditions. Indeed, there is increasing awareness that health care contributes only 10-20% of what we call health; the rest comes our genes, behaviours, social factors and environment.

To really care for health, then, we need to see more than just sickness and we need understand people’s health as socially constructed. I now see three inter-connecting spaces – health care, prevention, and health creation. The first two are defined by the bio-medical model, the third requires a new model – and with it a new language for value. And I see a growing role for community as you go from health care to health creation.

As communities start to define the agenda (as Sue Desmond-Hellman advocated) and we all work to understand each other’s language (as Sally Okun suggested we needed to) we’ll inevitably see more locally-tailored versions of health care and sickness care (as America Bracho is doing in Santa Ana, California). They’ll be context-sensitive and defined by what people want from their lives, rather than the pure pursuit of health. And because they’ll be based on how communities operate, they’ll have to embrace the complexity of the real world, their value being emergent, unpredictable, making the work to create health never-ending.

As I sat stage-side at TEDMED 2013, that was the future of health that I saw – complex, plural and a constant struggle. I liked it because I knew that it meant starting from what people really wanted and required a new type of relationship between clinicians and communities – one that is based on respect and leads to collegiality.

Innovators around the world are seeing community as the key to meeting the demand for care and for creating health. The question is whether the process can be sped up, whether established organisations in health care can look past their current definitions and help define and legitimise this new space.

I believe that they can, and I know that the Mayo Clinic’s Center For Innovation is one such organisation. Together we’re building a group of courageous organisations willing to work out how to make it all happen. Just like creating health through community, the process will be emergent, unpredictable. That’s okay; we’re ready for that. It’s time to start.

I will be at Transform this year. If you’re interested in health care, as opposed to sickness care, let’s talk. I look forward to meeting you. 

This post was first co-published on MedCity News and the Mayo Clinic’s Center For Innovation.

Pritpal S Tamber

I’m a doctor who trained as a medical editor and publisher and now researches and consults on the link between community power and health equity. My interest in community power started when I was the Physician Editor of TEDMED and is explained in My Perspective. I also work as a freelance medical editor and publisher for organisations that want to write high-quality articles and a strategy for their publishing and promotion. Find out more on my About page.

Leigh Carroll

Leigh Carroll is the special assistant to the president of the Institute of Medicine (IOM), and previously worked on IOM projects related to chronic disease and global health. Before working at the IOM, she taught high school science in rural Tanzania through the Peace Corps, and is interested in how neighborhoods can support formal and informal education. She was born and raised in Pittsburgh, PA.

Bridget B. Kelly

Bridget B. Kelly is a senior program officer at the Institute of Medicine, working on projects that cover a wide range of topics in health and education, using a diverse array of processes for convening, information gathering, and analysis and interpretation. She is also a dancer and choreographer with many years of experience in grassroots arts organizing.

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