The COVID-19 pandemic has brought to light the gross underinvestment in public health, primary care, and the social determinants of health in the United States. Yet, this experience gives us a chance to rethink our health and social service systems, as these are often siloed.
We see education, employment, healthcare, housing, and other social services as separate entities. The pandemic, though, reminds us that people do not live their lives in these kinds of vacuums. Rather, health is created by the whole of our access to safe housing, healthy foods, education, employment, and more.
Because of this, social spending and public health investments [pdf] have the utmost capacity to improve the main factors that contribute to health: the social determinants of health. The US, however, hasn’t yet adopted this philosophy. It’s important, then, that after COVID-19, we build back differently and better than before.
The Role of Primary Care
Within healthcare, primary care physicians are best apt to address the biopsychosocial components of patients’ health. And the COVID crisis has reminded us of the vital role that primary care physicians play. They are essential to preventing the spread of disease and maintaining the health of their communities.
The truth, though, is we shouldn’t have needed a pandemic to realize this. We’ve known for a while that the US spends nearly twice as much on healthcare compared to other Organisation for Economic Cooperation and Development (OECD) countries, yet has among the worst outcomes. Further, the US spends only 5-7% [pdf] of its total health expenditures on primary care, compared to the OECD average of 14%.
We also have plenty of evidence that increasing the supply of primary care physicians increases life expectancy. In fact, a 2019 study showed that the addition of 10 primary care doctors to a population results in a 250% more positive effect on life expectancy compared to the addition of 10 specialists to that same population.
Primary care physicians are in the unique position to improve population health [pdf] through ongoing care that engages patients in prevention. High-quality preventive care decreases the risk for developing chronic conditions like hypertension, diabetes, and heart disease. Primary care physicians also help patients to manage chronic conditions and coordinate any needed specialty care. And this helps keep patients out of emergency departments and hospitals.
In the US, though, rather than encouraging medical students to pursue primary care, we have incentivized students to pursue the medical and surgical specialties. We have elected to pay specialists a strikingly higher salary compared to primary care physicians. Essentially, the medical system has actively chosen to act contrary to the health of our population.
Common Cause
Beyond public health and primary care, we must further integrate our health and social systems to improve health outcomes. In order to adequately invest in the social determinants, we must reimagine federal policies and funding. This includes collaboration between, and possibly integration of, various federal agencies. This might include the US Departments of Health and Human Services, Education, and Housing and Urban Development, and others. We must make common cause to truly address the health of our nation.
To do this, we need elected officials who value and prioritize public health, primary care, and social services. That’s why I founded the organization, Doctors For A Healthy US, LLC, which advocates for political candidates who are committed to the health of our communities.
As a nation, we must come together to engage in conversations, listen to each other, respect each other. As a more unified people, we will create the health equitable policies we need to recover from the COVID-19 crisis and to build back differently and better than before. We must focus our efforts on public health, primary care, and social spending. That’s exactly what Doctors For A Healthy US, LLC is all about…we’re advocating for a healthier America.
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