Should Healthcare Institutions Be the Epicenter for Health?

1. Should Healthcare Institutions Be the Epicenter for Health? Patricia A. Gabow, M.D., M ACP Hot Issues in Health Care Colorado Health Institute Colorado Springs December 2016 April 2016

3. Should Healthcare Institutions Be the Epicenter for Health? April 2016

4. Should Healthcare Institutions Be the Epicenter for Health? Gabow 2016 What is Health? What is our health care system’s performance? What are the determinants of health and their impact? What is a way forward to health?

5. What is Health?

6. What is Health? Gabow 2016 Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.World Health Organization Some people need health care some of the time, but all people need health and wellness all of the time. Koh JAMA 2016

7. Determinates of Health Behaviors Health Care System Genetics HEALTH Income Community Education Environment Gabow 2016 7

8. What is our health care system’s performance?

9. What is our health care system’s performance? Gabow 2016 • Cost • Coverage/Access • Quality • Equity/Disparity

10. Health Care Spending Percentage of GDP, 1980–2013 * 2012. Notes: GDP refers to gross domestic product. Dutch and Swiss data are for current spending only, and exclude spending on capital formation of health care providers. Source: OECD Health Data 2015. Gabow 2016

11. Dimensions of a High Performance Health System Gabow 2016

14. Coverage/Access Gabow 2016 ACA major expansion of healthcare coverage 30 million Americans still do not have health insurance coverage (3/2015) Coverage doesn’t equal access

15. Efficiency Gabow 2016 15 America ranks 50th out of 55 countries in efficiency 30-40% of healthcare costs are waste ($765 billion/yr) Americans receive only 50% of the care they should As much as 30% of the healthcare Americans do receive is not valuable or even harmful

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19. Life Expectancy by Age International Comparison Before age 75, the US never ranks above 15 out of 17 countries Gabow 2016

20. Forbes, Dec 30, 2012; after Roth, Pittsburgh Post-Gazette, Dec 13, 2009. Gabow 2016 20

21. Life Expectancy vs. Spending on Health Care Gabow 2016 OECD Source: OECD, 2011.

22. Gabow 2016 BMJ 2016 22

23. Gabow 2016 JAMA INT MED 2016 23

24. Equity/Disparity Gabow 2016 There is marked disparity by race and ethnicity, socioeconomic group, and geography in: • Coverage • Access • Care • Mortality

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26. African Americans compared to Whites Gabow 2016 Low birth weight babies -Twice as likely Mortality in first year of life - Twice as likely Children with asthma - Twice as likely Stroke and heart disease in adults – 1.5 to 2 times Life expectancy 5 years less for men Life expectancy 3 years less for women National Academy of Medicine 2016

27. Dimensions of a High Performance Health System Gabow 2016

28. Dimensions of a High Performance Health System Gabow 2016 RWJF County Health Rankings

30. What is our health care system’s performance? Gabow 2016 We have significant issues in our health care system’s performance • Cost • Coverage/Access • Quality • Equity/Disparity The system also suffers from duplication, fragmentation, misalignment between physicians and patients, adoption of new technologies of uncertain efficacy NAM

31. “Why despite a higher expenditure than almost any other country have we achieved less health?” “A major reason lies in the fact that the foci of our attention, our resources and our incentives are too narrow….our investments are primarily directed to biomedical (focus)…” National Academy of Medicine 2016 Gabow 2016 31

32. Health and Social Spending as a Percent of GDP

33. What are the social determinants of health and their impact?

34. Social Determinates of Health Behaviors Health Care System Genetics HEALTH Income Community Education Environment Gabow 2016 34

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37. Income Relationships Low Income Status Food Insecurity Housing Insecurity 42 million people 41 million people Impact on Health

38. Income Gabow 2016 Association between income and life expectancy in US, 2000-2014 • Life expectancy at age 40 increases with income percentile • Life expectancy at age 40 for the wealthiest 1% is 10-15 years greater that that for poorest 1% • Life expectancy for men at age 40 in the poorest 1% is that of men in Sudan • The rise in life expectancy associated with income becomes less above $200,000 Chetty JAMA 2016

39. Gabow 2016 JAMA 2016 39

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41. Social Determinates of Health Behaviors Health Care System Genetics HEALTH Income Community Education Environment Gabow 2016 41

43. Education • 79.7 years with college degree • 72.9 years without finishing high school • 83.5 years with college degree • 78.4 years without finishing high school Gabow 2016 The effect of education on longevity

44. Social Determinates of Health Behaviors Health Care System Genetics HEALTH Income Community Education Environment Gabow 2016 44

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46. Impact of Environment Air pollution is a major environmental risk to health. Reducing air pollution levels reduce the burden of disease from Stroke Heart disease Lung cancer Chronic and acute respiratory diseases, including asthma World Health Organization

47. Behaviors • Tobacco use • Diet • Physical inactivity • Alcohol and drug use • Sexual practices • Injurious behaviors Gabow 2016 Behaviors that have an effect on health

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