In the new US consumer marketplace, doing good for society is powerful.
Choices that people are making about how their food is grown, how companies test household products and reduce their impact on the environment, and how companies make their profits are driving new business models. Farmers are changing their pest and weed-control methods, manufacturers are choosing and featuring safer ingredients, and businesses are adopting less exploitative and more shared-benefits models.
Take coffee as an example
We all love a good cup of coffee (or, okay fine, tea). If given the chance to choose, many people today also would like to get their caffeine buzz with less of a negative impact (or even some benefit to the world). A cup of coffee that is organically grown, fair-trade certified, and served in a recycled/recyclable cup is one step. If buying that coffee also generates funds to protect a rain forest (say, 5% of profits), that’s a second value-added step. If the company operates its business ethically (e.g., paying livable wages) and transparently, that’s a third. Those steps are attractive and increasingly good business in many sectors.
One market where the transition to more socially conscious business has been notably absent is in US health care. There are many non-profit organizations already delivering low-cost or free care, and that is certainly socially conscious. But with a medical system marked by a lack of transparency and plagued with socioeconomic inequality and sometimes vast gaps in quality and safety, there is good reason to think that there could be a large demand for, shall we say, more “ethically sourced” medical care.
Call it P-Corp certified medical care (akin to the B-Corporation, but with an emphasis on public health), fair-trade medicine, or cruelty-free health care. The time is ripe to enable socially conscious people to more easily find and reward medical providers that deliver great medical care in a way that does right by the society. Why shouldn’t we expect our health care purchasing to have a social benefit?
Buy one, give one health care? There are many good models from other sectors
Many non-profit agencies and the US government have worked for decades to set aspirational, but achievable, standards for social and environmental benefits. Doing so also requires many complex layers of marketing to build both a business and consumer base to adopt them.
In agriculture, most people know Certified Organic from the US Department of Agriculture, Fair Trade Certified (for better trade and farming practices), and Rainforest Alliance Certified labels. For household products, there is the Safer Choice label from the US Environmental Protection Agency (for products with safer chemistry), the Leaping Bunny (for animal cruelty-free products), and Environmental Working Group verification for safer chemical choices in cosmetics. In textiles, it’s the bluesign label for sustainability in manufacturing.
For socially conscious, ethical and transparent business practices, the most well-known standard is the certified B-Corporation. According to the organization, businesses that receive this certification meet “standards for social and environmental performance, public transparency, and legal accountability.” This certification includes a range of social benefit metrics that uniquely reflects the many ways in which companies have large and tangible impacts on the world.
Why socially conscious medical care?
Given that medical care accounts for nearly a fifth of the economy in the US, it has a large and obvious impact on many aspects of society. In addition to its contribution to health and long life, the medical sector has an impact on economic wellbeing: it employed about 9% of the total US workforce in 2015.
It also has a real impact on the environment. Hospitals and clinics have a big carbon footprint contributing, in one estimate, up 8% of total US carbon emissions. And hospitals are not known for being efficient users of supplies. A fascinating 2017 report from ProPublica described the staggering volume of waste (including perfectly good supplies) in US hospitals.
Medical care also has an impact on social equality, opportunity, and culture. At my university, for example, the turmoil over the past year of multiple ethics violations by two former deans of our medical school (one for a complicated web of alleged drug use, and the other for a prior sexual harassment settlement), and years of alleged misbehavior of a gynecologist at our student health center, have thrown the community into chaos. This is part of a larger societal reckoning, and one that needs greater sunshine still in the medical system.
The US medical care system already has certification programs for quality and safety of care. Hospitals, agencies, and clinics can seek certification or receive quality and safety ratings from the National Committee for Quality Assurance, the Joint Commission, and the Leapfrog Group. Medicare and private insurance companies also publish quality ratings. The Baby Friendly Hospital Initiative, created by United Nation’s Children’s Fund (UNICEF) and the World Health Organization, has also spurred breastfeeding support initiatives in hospitals worldwide, including more than 500 hospitals in the US. Unfortunately, it is not clear whether patients know about, or seek out providers because of, these certifications.
The demand for socially conscious purchasing is very high. A 2015 market-trend survey of almost 10,000 demographically representative adults in the nine most economically productive countries (including the US) found that 9 in 10 people believe that companies should do more than just make a profit by acting responsibly and addressing social issues. More than 7 in 10 people would be willing to pay more for a product that is socially or environmentally responsible, and more than 6 in 10 did so in the past year. Whether this might influence how people choose medical care providers is an unanswered question.
What could socially conscious medical care look like?
While the criteria for any certification should be developed in concert with a range of stakeholders, the framework could be guided by the public health (and non-medical) emphasis set forth by the World Health Organization’s initiative on the Social Determinants of Health.
Here are some ideas for setting standards that overlap with that framework:
- Employment: The provider or organization should help its workers become economically stable and actively reduce income inequality. Standards could be based on the organization’s benefits, training opportunities, and compensation structure (e.g., the highest-paid position makes no more than 5 times the wage of the lowest-paid position, as at Dr. Bronner’s).
- Environment: The medical setting should be a place that promotes a healthy environment. Standards could be based on the organization’s environmental footprint, including energy efficiency and energy-source choices, transportation options (e.g, locating close to public transportation, etc.) and polices about green office supplies, reducing waste, and other sustainability measures.
- Inclusion and Diversity: The medical system should be inclusive and support civic society. Standards could be based on improving access to health care regardless of the ability to pay (e.g., setting aside 5% of visits for free or low-cost care), reducing racial and gender bias in delivering care, and giving workers paid time off to volunteer and vote (as at Tom’s of Maine).
- Public Health: Providers should actively promote public health. Standards could be based on reducing inappropriate antibiotic use (to reduce the growing public health threat of antibiotic resistance), prioritizing prevention (such as appropriate screening), and adopting methods to address social determinants (such as using tools like HealthBegins).
- Transparency: People should be able to trust that medical organizations prioritize patient well-being over money. Standards could be based on verified absence of paid relationships with (and visits by) pharmaceutical or medical device companies, no ownership arrangements that create conflicts of interest, and refusing to balance bill insured patients.
Developing such a certification would be complex, and there are legitimate reasons for skepticism about the value of even well-established certifications. But the ability to offer patients a choice of more socially conscious providers and organizations is an idea worth exploring. If you have ideas about what other factors to consider, or how such a system could work, please reach out.
While I wait, I’ll go look for another cup of organic, fair-trade coffee.
Gregory Stevens