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America can move toward a health system that is responsible for our well-being and a new state of public health led by medical professionals.
Covid-19 has crippled the US health care system and shed a lot of light on the social determinants of health.
In doing so, the virus — and more importantly, its aftermath — has exposed a truth that my colleagues and I have been preaching for more than a decade: public health is outdated and inadequate. His major ideas—including public health, epidemiology, behavioral science, and the environment—are important but counterintuitive.
We must also consider the quality and safety of the care we provide, the cost of care, and various public policies.
Health business
Health care is the biggest business in this country, but we rarely stop to think about what that business is.
Are health care providers in the business of promoting and maintaining health? Or is our goal simply to perform more procedures and fill all beds?
Most doctors I know feel too disconnected from the system to answer. When they have to balance public health with treating the sick and protecting people’s health, they see themselves as puppets or, worse, victims. Increasing care disparities and requiring careful SDOH.
Consider the social issues in a city like Philadelphia, where I have worked for the past three decades. It is the poorest among the top ten cities in terms of population. A quarter of Philadelphians live in poverty and half are in deep poverty, meaning they can’t put food on the table. As the epidemic spread, food lines for medical aid went beyond the line.
It’s no surprise, then, that the death rate for people of color is much higher than other patient demographics. Inherent inequities in our system were lack of access, lack of resources and lack of insurance for people who are vulnerable to the virus because they have to work in public.
Internally driven
Doctors are not social workers, but when there is a flood, instead of waiting to solve the downstream, when it is still a trickle, we work to stop the disease from the source.
Imagine if the population of Philadelphia was healthy before covid; If we had less inequality, we could reduce the incredible death rate among minority populations. If we had paid attention to obesity, smoking, heart disease, exercise, diet, the system would have paid less attention to them, because there were no incentives to do otherwise. Indeed, the flood fills many beds.
As an academic, I have been pushing the public health paradigm for over a decade. This means changing the curriculum of undergraduate and postgraduate medical education. Let’s bring public health principles to UME and GME.
Has the pandemic given us a rocket boost to finally get this information into the curriculum? I hope the answer is “yes,” and soon we’ll see pharmacy schools, nursing schools, and medical schools incorporate the principles we preached pre-Covid. I also hope that we will see digital healthcare continue to drive down marginal costs. Both changes allow us to reach a much larger population at a lower cost than ever before.
There is a caveat: change only comes from within. The health care system is so large, so entrenched, and dominated by commercial interests that the revolutionaries, like my colleagues advocating for public health practices, must construct the equivalent of a Trojan horse to bring about change.
Fortunately, and unfortunately, Covid has taught us that the system is not as strong as it appears. Leadership failures, racial inequities, public health failures, and institutional failure — including public health — have exposed a fragile core surrounded by thick, high walls.
Let’s break through those walls, assess what’s rotten, and identify the root causes of how COVID-19 has crippled the healthcare system. Killing more than 1 million Americans. Even without new laws or government policies, I am confident that America will move toward a transformed health system and a new public health environment led by medical professionals. Failure to do so is malpractice.
– David B. Nash, MD, MBA, Advisory Board Member at MediGuru, as well as Founding Dean of the Jefferson College of Public Health and Dr. Raymond C. and Doris N. Grandon is a professor of health policy on the campus of Thomas Jefferson University in Philadelphia, PA
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