More Than a Repair Shop

Our healthcare system serves as a trusted source of information; a safe space to discuss stigmatizing aspects of our lives; a place to be immunized against deadly viruses, have broken bones repaired, find and treat cancer. BUT while this is so important and so obviously make us healthier – we are not spending our health care dollars on 100% of what contributes to our health.

Having a place to live that is safe, being able to eat fresh and unprocessed food, having a place and time to exercise, not being stressed, positive human interaction are all social determinants of health. Some of these things are within a person’s control and some are not. A health care system can help contribute to some of these but not all. We have a disconnect between where we spend money for health and what truly makes us healthy.

When we talk about the determinants of health I think of how the computer game the Sims shows a green diamond above a person’s head with scales of hunger, sleep, social etc that go up or down with various inputs and outputs. We are just slightly more complicated. Traumatic childhoods are related to depression in adulthood – input and output. Our bodies are imperfect and some of us are dealt worse hands at the start; genetic heart defects, prenatal exposure to opioids. Some of us are dealt bad hands as we move through life; exposure to cancer-causing asbestos, abuse or neglect.

When we talk about the determinants of health I think of how the computer game the Sims shows a green diamond above a person’s head with scales of hunger, sleep, social etc that go up or down with various inputs and outputs. We are just slightly more complicated. Traumatic childhoods are related to depression in adulthood – input and output. Our bodies are imperfect and some of us are dealt worse hands at the start; genetic heart defects, prenatal exposure to alcohol. Some of us are dealt bad hands as we move through life; exposure to cancer-causing asbestos, abuse or neglect, poverty, neighborhood violence. 

In a recent article The Moral Determinants of Health, Dr. Don Berwick frames hospitals and physician offices as mere repair shops that work to correct the damage of the social determinants of our health. We treat the adult depression instead of preventing the childhood exposure to abuse. We treat the type 2 diabetes rather than providing universal access to affordable, nutritious food. So far we have decided as a society that we are ok with our healthcare system as a repair shop, making money fee-for-service to repair the broken bits of our individual bodies and minds. We are not spending our health care dollars on what would have the greatest impact on health.

We are living through chaos – through a moment in history where our American health care and public health systems are not achieving the goals that I think we all share. Dr. Berwick calls on us all to help one another “secure the basic circumstances of healthy lives” including addressing the racism that pervades all our institutions.

We have an opportunity through this crisis to question whether we can continue to be ok with merely being a repair shop. I hope not and I think we have a real opportunity to expand and to redefine what health care does. I hope that the vision of a healthy Washington state is shared by everyone. We need to understand our action plan to get there, namely how we can maximize the health care delivery structure that we have, build or augment the inherent skills within providers and teams, develop incentives to overcome resistance, and provide resources to avoid frustration.

We may be slow learners, but we do learn. Yes change is hard, but that is not an excuse. The time for excuses is past.

Ginny Weir, MPH
Director, Bree Collaborative