The Purpose of Healthcare

Gary Cohen
April 2, 2014
Skoll World Forum

Access to healthcare has become one of the defining issues of our time. While in many countries the fundamental challenge is how to provide basic healthcare services and deliver essential vaccinations, in the United States healthcare has become a political football where Congressional leaders fight about who should get health insurance and who should pay for it. What's missing from these discussions is a more fundamental question: what is healthcare for?

We are learning that our health is highly dependent on the social and environmental conditions in which we live and work. Air pollution, chemical exposure, poor quality food and poverty are all more predictive of health outcomes than our genetic makeup. Yet our healthcare system has largely ignored these factors when delivering healthcare. In the US, 70% of all healthcare expenditures are devoted to treating chronic disease, while only 4% are devoted to preventing it. This approach has led to the institutionalization of a sick care system that now accounts for 18% of the total economy. Outside of the military, healthcare is the largest part of the GDP.

Yet despite the fact that we spend more money than any other nation on healthcare, our health statistics lag behind most other industrialized countries. Our cancer rates are one in two men and one in three women. Obesity rates are approaching one in three Americans. Asthma is increasing in our youth. If we continue to focus largely on treating chronic conditions in individual patients, we will certainly help people live longer with their diseases but we will bankrupt the system in the process.

What if instead of spending most of our healthcare dollars of treating sick people, we pushed healthcare upstream to address the social and environmental conditions that make people sick in the first place? What would this look like?

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