Five Numbers That Could Reform Healthcare | Randy Oostra | TEDxTraverseCity

so it was one of those uh great saturday mornings uh you know the type when you get a sleep in and have a nice relaxing day a young man rolls out of bed to get that second cup of coffee and as he's coming back into the uh bedroom his wife is standing in the door of the bathroom and says han come on in i want to show you something so he walks in the bathroom and there on the counter um of the sink is a positive pregnancy strip they both yell and scream they hug each other they they jump back into bed and they begin to talk about all the sort of things that you would talk about when you're expecting a baby um you know it's going to be a boy or a girl doing do we need to quit our jobs do we need a bigger house uh when do we tell our parents boy this is scary how are we going to be able to afford a baby how are we going to find child care all the sort of things that a young couple would would talk about so on monday morning uh as it rolled around they were able to call the obese office and make an appointment for later that week both took the day off went in to see the obstetrician and did the sort of things that you would would typically do in a doctor's office filled out the forms you know sat in the waiting room they were brought back um of course again just verifying some information did you know height and weight and blood pressure took some lab tests and also did a first ultrasound so as the staff person was sitting there talking to the young couple getting all that information validating information asking them certain questions all of a sudden she became very very quiet and very noticeable to the young couple and made them both very very nervous and they sat there in silence as a young woman said to them the doctor will be in to see you in a few minutes so definitely a change in tone a few minutes went by seemed like hours to the young couple and finally the ob gyn came in and after some pleasantries and congratulating the young couple talking about this great part and their life great moment in their life began to talk a little bit about the practice and then again very quietly uh grabbed the stool pulled it up and she looked at them at the end and the eyes and said you know i'm very very concerned about your baby very concerned about your baby's diagnosis and the young couple looked at the doctor and thought diagnosis you know this is our first visit what do you mean diagnosis and she said well your baby is a 4-3-6-0-4 and the young woman said 4-3-6-0-4-4-3-6-7-4 that's our zip code and the physician looked them in the eyes and said exactly and what we found in our country is that the five most important numbers in your life many times is your zip code the zip code of where you were born who your parents were how you lived your life the social and economic conditions of your life and that alone that in genetics has more to do about your health and well-being than anything we do in health care any clinical thing we can do and again as we've seen the events unfold over the last few months one of the things that people now hear about are these social economic factors something we call the social determinants of health in the united states if you go to our major cities and rural areas across the country you can see a 10 a 20 a 30-year difference 30-year difference in life expectancy in the united states so so how in the heck does that happen how can you literally be blocks a quarter of a mile away from each other and have a life expectancy difference of 20 plus years and why we talk more about it why has that not been an issue and a lot of these issues it's just been our indifference to these issues it's not that we haven't known about them it's not that parts of our society have worked to address these we've just never integrated them into the way that that we take care of people in our lives so right now we have a large industry large health care industry that really is on a path they've been on a path uh since the 1930s almost a hundred years path and if you look at how they've consumed resources in this country the amount of dollars spent on health care just continues to climb and probably the last dozen presidents have all said the same thing we have a major problem in our country in health care spending is out of control we said that when it was five percent of the gdp we said it when it was 10 of the gdp and now in just a short period of time it'll be 20 percent of our growth semester product and there's really nothing we can do about it it's demographic driven it's trend driven and yet we spend six trillion dollars on health care and you really have to ask yourself is that really the right thing to do given how we think about health care today and you've seen these statistics along the way when we begin to look at what we get for the six trillion it's one thing to say oh man we get it's like going to the four seasons it's the best everything is taken care of but yet we have this huge difference in life expectancy costs which are a critical issue in our country the number one cause of personal bankruptcy is related to health care costs seniors 85 year olds filing bankruptcy at an all-time high why because of health care costs we have more preventable deaths we have high instances of hospital-acquired infections uh deaths from medical errors and so you begin to look at all these issues you say well uh your truly is this relationship how we should spend our six trillion dollars and this graph is the countries we typically compare our suit compare ourselves to and the lighter boxes point out that you're actually worse than the other countries and as you see the united states is very lower so we have 30 million people that are uninsured in this country 30 million people and yet when you begin to look at the financial impact on them and what we're getting for our dollars you have to really ask yourselves about the model so one in three people say they can't access health care because of cost one in three people say the biggest worry of their lives is health care costs one in ten one in ten americans in a gallup poll in the last few months reported that they knew someone who died premature prematurely because they couldn't afford health care so as we think about our health care system and we want to celebrate our health care health care system we really have to be concerned that we really have the right model so one of the things that we have seen in the last couple weeks unfold with covet and house covet has impacted certain racial and ethnic minorities at a much much higher rate and all of a sudden we're talking about social and economic conditions and what many people would call the social determinants of health the who defines social determinants of health is really those things that kind of go back to your zip code where you grew up who your parents were what kind of home you lived in what kind of resources what kind of opportunities you have that is more important to your health and well-being than anything we do clinically in healthcare settings and as you look at the chart here twenty percent of health care twenty percent of your health and well-being is related to health care and the other things are far more important in your overall health and wellbeing and it kind of makes sense uh you don't hang around hospitals every day if you think about your health and well-being you don't run to a hospital but but it's those things that are critically important so about a decade ago i worked for a healthcare organization and we thought we would um you know address obesity and a lot of health systems around this country do what they call community needs assessments and it was part of the affordable care act it is something that we have been most most health systems have done for a long long time even before the affordable care act and you know we we looked at kind of what came out of it we said well bc is a problem let's invest some dollars in obesity so we created these great learning maps uh we hired uh you know um trainers and we created maps for different sort of ages and for their for their parents and we put them into the schools and the summer clubs and the y's and all those sort of things so this goes on for a while we felt pretty good about ourselves and after four or five months the um the trainers asked for a meeting and they weren't happy and they they said this isn't working and we said okay what do you mean it's not working these kids are hungry and our response was no no no we didn't sign up for hunger we signed up to teach them to eat healthy and they go they can't eat healthy because they can't afford good food and their obesity is linked to the food and what we found out is that food is a major health care issue in our country pretty basic healthy moms healthy babies we just you know want to make it a welfare issue in our country and so we have this issue that food is medicine hunger is a health issue 13 percent of households are food insecure uh 19 of their children 33 of single moms and and children are food insecure that means they miss 100 meals a month and the meals they do have aren't all that good and yet we spend six trillion dollars on all the stuff in health care and we have people uh in in our communities all over our nation that are struggling with food insecurity and what this led us to do is we've now screened for food insecurity for over 10 years we've done you know three to four million screens we provide short-term food needs baskets of food make food available we have food pharmacies where doctors can write scripts and individuals can sit down with a counselor a dietitian and really plan out meals that they can afford that are nutritious and especially if they have some medical conditions we started an inner city grocery store in a food desert because no grocery store no grocery chain would help us we've done farms mobile meals and and really this idea is how can we take care of someone clinically and yet not look to all these social issues in life and so what we've done over the last decade is now we've begun to screen for the 10 social determinants of health and go back again we can spend all this time and effort taking care of someone clinically but wouldn't it make sense to you that when you went into a doctor's office they asked you do you have access to good food can you really take care of yourself from a nutrition standpoint do you have the economics to take care of yourself um you you live in a safe home uh do you have money to afford the procedures i'm going to ask you to do and the the prescriptions i'm going to give you behave your health you have utilities on you have transportation do you have employment all those things are critically important but yet we look at a person physically and yet we never look at these socially determined health and if you think about how healthcare has evolved in our country it's really not made all that much sense and the problem um that we have is that for all the right reasons we built hospitals across america and uh today we have some you know major beautiful hospitals one of those is an organization i work for uh you have to have glass on your on your big buildings today and really we have a hospital-centric model and it's been that way since world war ii when because of the hill burton act we built six seven thousand facilities in four thousand communities and guess what we still think of hospitals as a central part of your health and my guess is you do not i do not uh and really when we think about care and the type of kind of care that we want to deliver in the future it's really much more consumer based it's much more holistic it has to take into account the social determinants of health and other things including life purpose and really what we need to do is move away from this hospital-centric model what kovit has taught us is that hospitals are critically important absolutely we do not need more hospital beds in this country by the way what we need to do is invest in those services outside of hospitals and we have a broken health care system we need to fix it and now is the time to fix it what we do have though are the best caregivers in the world no doubt about it but we've asked them to work in a model that that really doesn't work so really it's time for a new model and in it starts with reallocating our spending we are spending a lot of money we have this massive healthcare industry pharmaceutical companies hospitals insurance companies medical device manufacturers we're spending tremendous amounts of money and it's a major issue it's a major industry it's a major political force and either we all need to spend more money in order to address these other things taxes more or we really need to reallocate health care spending hard thing to think about hard thing to do very very political we need a national focus on the social determinants of health when we look at the impact of covet and why covet has impacted certain minorities uh and and not others it's because of those social conditions it's because of their social and economic health and we don't have any focus we should mandate tomorrow that every health care facility screens for the 10 social determinants of health and oh by the way we are now screening employees we screen our employees with the idea that that if you screen employees you can interact in their lives higher retention higher recruitment lower health care costs higher productivity doing those things for your employees for all the right reasons as well we need to invest in senior care um kind of a travesty what's happening right now in senior care in this country everyone is throwing shots at senior care governors media lawyers and really what do we expect it's a bit of hypocrisy to complain about senior care when we reimburse senior care less than we do a budget hotel and for that we're expected to provide great clinical care with with the with the best staff beautiful facilities three meals a day and all these opportunities to you know be involved in activities and mental stimulation it just doesn't work it's a highly heavily regulated industry and yet we we think we care about seniors but we don't and it's this whole idea in our country that we don't value our seniors and again one more time as we think about investing and where investment should be senior care is one and of course we've seen our problems in public health huge problem in public health in our country as health care costs went up 50 um public health investments went down 25 percent and over the last decade a reduction in about 25 of their staffing and what we've seen is we don't have an integrated public health system we're not prepared it's not linked we not we don't have the right data and we don't have the right stockpiles that needs to change rapidly so how do we do that so for the last several years we've been in washington lobbying for a national commission on health why a national commission on health because nothing's going to change otherwise the model is going to continue we're going to go from 19 to 20 to 25 percent of our gdp we have a long history of national commissions we've had over 125 national commissions some of them very very successful and the charge to a national commission would be this this is a model that can't continue we need to invest in these other issues so either we need to increase taxes or we need to find a new model and we need to move money from some of the things that we've put invested in historically and move them to some of those other areas and we need to do that over a period of time a decade maybe two decades but at least we would have a new model so the question for all this is this zip code going to be the most five important most important numbers in people's lives sitting here today a pessimist would say oh absolutely this you know this two will pass and nothing will change and optimists would say no now is the time this is about america's priorities this is about america's collective will and a lot of things what we've learned over the last few uh weeks and months it's about our character it's about the choices we made and you know i think if you step back and think about it if there was ever a time we address these issues now is the time thank you very much

Channel: TEDx Talks

Views: 9,994

Keywords: TEDxTalks, English, Health, Medicine

Id: JybvaX9kN0M

Length: 17min 38sec (1058 seconds)

Published: Tue Aug 04 2020