Four Ways to Shape the Future of American Healthcare
Preventing disease cannot only be the province of public health, especially after the pandemic revealed the impact that gaps in healthcare access and equity have on cities, states, and the country. U.S. healthcare companies and community health leaders must work together to shape the future of American healthcare and improve patients’ lives.
At the Nashville Health Care Council’s 2022 Council Fellows Summit, Senator Bill Frist, M.D., and Meharry Medical College President and CEO James E.K. Hildreth, Ph.D, M.D., offered four opportunities for private and public sector leaders to make an impact on the future of American healthcare: data, nutrition, climate change, and improving conversations surrounding the country’s toughest medical challenges.
“The healthcare industry does a great job of taking care of sick people,” Hildreth said. “[But] when it comes to keeping people healthy and preventing disease in the first place, not so much.”
Addressing these four priorities will improve healthcare access and equity, reduce the amount of money spent each year to address chronic diseases, and save lives.
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Healthcare companies must help build data infrastructure
Building better data systems is an essential component of the future of American healthcare.
As part of President Biden’s COVID-19 Health Equity Task Force, Hildreth found that in many places around the country health data is not collected, much less disaggregated. During the COVID-19 pandemic, some entities openly refused to analyze patient information since they did not want to make decisions based on race or any other demographic factor.
“We need to make sure we’re incentivizing large organizations, whether they are health delivery systems or hospital systems, to collect and disaggregate data and make health equity decisions based on the data,” Hildreth said.
Frist said healthcare companies must be willing to share data with each other and with community health officials.
Companies also must be willing to invest in integrated healthcare databases. One option is to support the new Belmont University Data Collaborative, which provides data for community level projects that can expose and transform healthcare challenges into actionable solutions. The Collaborative’s information already is being used to address mental health and hypertension.
Hildreth said the healthcare industry must change how it generates disease data. Right now, thousands of human genomes have been sequenced, but only 1.2 percent come from people of color, Hildreth noted, since underserved groups are not represented on patient panels. “We have to make sure the datasets that are being used to make decisions and to derive the algorithms represent the whole population,” Hildreth argued.
The National Institutes of Health’s “All of Us” initiative is building a diverse database to inform thousands of studies on a variety of health conditions. Ultimately, this research will help:
- Identify the risk factors for certain diseases
- Figure out which treatments work best for people of different backgrounds
- Connect people with the right clinical studies for their needs
- Learn how technologies can help us take steps to be healthier
The NIH is hoping to attract more than one million Americans to the project. Provider organizations can participate.
Community health organizations need to work to improve nutrition
Two of the key recommendations made by President Biden’s COVID-19 Health Equity Task Force were to ensure every U.S. child has access to preventative healthcare and to address social determinants of health.
Improving nutrition is a key component of both priorities.
“If a child eats healthy and is physically active, they are pretty much set,” Hildreth said.
Frist agreed. Nashville may be an epicenter for healthcare companies, but it has higher infant mortality, poorer mental health outcomes, and lower life expectancy than cities of comparable size, in part because residents have poorer nutrition and exercise habits.
“We need to do something about it locally,” said Frist, who founded community collaborative NashvilleHealth in 2015 to begin to address these challenges.
Hildreth and Frist said healthcare companies should reduce their own food waste, support policymakers who make nutrition a fundamental part of their healthcare agenda, and advance research that explores how to change behavior surrounding nutrition.
Community health organizations also are an important part of improving nutrition.
Live Well San Diego, an organization whose mission is to improve wellness for all 3.3 million San Diego residents, focuses on three of the main contributing factors to chronic disease: smoking, lack of exercise, and poor nutrition. When the organization was launched 10 years ago, 57 percent of all deaths in San Diego could be tied back to one of these three factors.
By bringing together more than 400 organizations — from public health departments to hospitals and churches — to address the five social determinants of health (health care access, social context, the built environment, economic stability, and education access), Live Well San Diego has helped reduce the percentage of deaths associated with preventable health factors by 12 percent.
“The results have been quite amazing,” said Hildreth.
Hildreth said medical schools are reducing chronic disease by making it mandatory that students take courses on nutrition. Colleges like Meharry also are driving research on the connection between nutrition and disease.
Since 2019, Meharry professor Stephania Miller-Hughes, Ph.D, has been investigating an alternative method for providing diabetes medical nutrition therapy to Black women. Her method combines diabetes medical nutrition therapy with motivational strategies to increase healthier eating. After going through the program, participants had improved blood sugar levels and were more confident in choosing healthier foods.
Read more about addressing social determinants of health
Healthcare companies must reduce climate impact
Climate change impacts both physical and mental health.
“As heat goes up, there’s more suicide, there are more mental health problems, there’s more depression, there’s more anxiety, there’s more death,” said Frist. “The clear-cut relationship between the heat index and mortality – from heart disease, from lung disease, from kidney disease is proven scientifically. It affects us all. Disproportionally it impacts marginalized populations.”
It is not enough for healthcare companies to help patients suffering from climate change outcomes. Ten percent of all U.S. greenhouse gas emissions are generated by the healthcare sector. That industry has a “responsibility” to measure and reduce its own carbon footprint, Frist said.
Some solutions are simple.
Cleveland Clinic reduced its carbon footprint by reducing air circulation in operating rooms when not in use. That single decision cut the clinic’s energy costs by about $2 million per year, Frist said. To reduce its transportation footprint, Cleveland Clinic offers transportation programs and incentives for employees, including pre-tax public bus and rapid transit system passes, rebates for purchasing green vehicles, and incentives for living near work. Over the last 12 years, Cleveland Clinic has decreased its carbon emissions intensity by 33.8 percent and its total emissions by 23.9 percent.
Private and community health organizations also can participate in the National Academy of Medicine’s (NAM) effort to decarbonize the healthcare sector. NAM’s Climate Collaborative is a neutral platform for participants to align around collective goals and actions that are based on evidence. Already, more than 110 organizations around the world have joined the effort.
The future of American healthcare must be apolitical
Many of these questions — even those surrounding childhood nutrition and vaccines — are infused with politics.
Hildreth is a voting member of the U.S. Food and Drug Administration’s Vaccines and Related Products Advisory Committee. When the panel considered approval of the COVID-19 vaccine for children, observers, including some federal lawmakers, accused committee members of “killing children.”
Science is being “subordinated” to politics, Hildreth said, and it costs lives. “We’ve got to find a way to make sure that healthcare, public health, and science are not supplanted by politics.”
Hildreth and Frist emphasized that healthcare companies and community health leaders must remain above politics and focused on solutions that unleash innovation and improve health care access.
In September 2022, Frist attended the White House Conference on Hunger, Nutrition, and Health — the first conference of its kind in 50 years. Nonprofit organizations, businesses, and local leaders each must take a seat at the table.
“It’s important for us all to show up,” Frist said.
Focusing on solutions, access, and innovation ultimately will save lives — and money, Hildreth said. The United States spends $4 trillion on healthcare each year. He said if the industry found a way to address chronic diseases that affect mostly minority populations, it could trim that number by 25 percent.
“What could we do with $1 trillion? Every medical school student, every nursing student, and every dental student could go to school for free — and that’s just $400 billion,” Hildreth said.
Learn more about NHCC’s Fellows program
The Nashville Health Care Council Fellows Summit provides the opportunity to learn about new strategies to address healthcare’s most pressing challenges, hear from healthcare thought leaders and set the stage for the development of innovative healthcare solutions.