Introducing The Aggregate Patient
I ask myself “what is health?” and because I am that person who talks out loud and answers my own questions, I answer “health is how life feels for you.” Then I say to myself, “self, what is healthy?” and I respond “healthy is having the capacity to explore happiness and joy.” What is healthcare? The more I was engaged as a patient in health care discussions, I learned that policy makers and key opinion leaders had ideas on how to change health care and make it more patient-centric, sustainable, efficient, always more of something. The targets vaguely defined, the outputs unclear, the evaluation incomplete. The evidence not formalized. The funding interrupted. We’ve ended up with more layers and more is less. I don’t think our healthcare system is patient-centric and I am not sure that it should be. Who is the aggregate patient at the centre of healthcare? Patient engagement became a priority, a buzzword, part of a job description, a component of a performance review, an increase in pay, but it never actually happened to the patient. There were no resources for support and no follow through to assess whether patient-centricity was making a difference in health outcomes, and if so, which ones and why? Patient-centric is a marketing strategy. A strategy that has resulted in healthcare policy shifting its priorities and resources away from those that are vulnerable to those that have and want more than they already have. That doesn’t seem equitable to me. I don’t think sustainable is the right word for healthcare. Healthcare will always be here one way or another. I think relevant is a better word. Is our healthcare system designed to have the greatest increase in population health at any given time with whatever resources we have at that time? To be relevant, I would like to see the pendulum swing far over to education, prevention and health promotions, from where it is now hanging, in diagnosing, treating and extending. We’ve neglected populations at risk. We treat we don’t care. We fix we don’t heal. For me, being sustainable is ultimately about being fair. It will always be a challenge for healthcare to be efficient, there will be pressure on voters to cut taxes but not services until apathy is addressed. An efficient healthcare produces positive results. We currently have a health care system where programs, services, priorities are added-on. More layers. More duplication. More overhead. Money and time is spent on resources while innovative services and programs struggle for ongoing funding and programs that empower individuals and communities start but they don’t continue, wellness gets interrupted. To be efficient, effective support must be continuous. Healthcare is a complicated system. What should the system do? For a universal healthcare to function it must be realistic and operate at the population level so that it gets the most for the most. I think we have drifting from who and what those “mosts” are. Corporate greed is creeping into health care and I’ve had enough of it. It has set the market value of lived experience at zero, and our healthcare system is shareholder-centric rather than patient-centric. I believe there is an approach that can be the foundation of health care policy and decision making that will stop the creep. What if the vision of healthcare became to fundamentally address the social determinants of health? What are social determinants of health? According to the World Health Organization (WHO) and this is cut and paste from their website http://www.who.int/ accessed on May 27, 2014. The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries. To elaborate further The Public Health Agency of Canada, again cut and paste from their website www.publichealth.gc.ca accessed on May 27, 2014 illuminates: Key Determinants: Income and Social Status Social Support Networks Education and Literacy Employment/Working Conditions Social Environments Physical Environments Personal Health Practices and Coping Skills Healthy Child Development Biology and Genetic Endowment Health Services Gender Culture And on their website PHAC continues; The challenge we face is how to use what we know about the determinants of health to: focus our research agenda so we can increase our understanding of how the basic determinants of health influence collective and personal well-being adopt strategies that improve health for Canadians That’s where a population health approach comes in. In a population health approach, taking action on the complex interactions between factors that contribute to health requires: a focus on the root causes of a problem, with evidence to support the strategy to address the problem and efforts to prevent the problem improving aggregate health status of the whole society, while considering the special needs and vulnerabilities of sub-populations a focus on partnerships and intersectoral cooperation finding flexible and multidimensional solutions for complex problems public involvement and community participation A population health approach recognizes that any analysis of the health of the population must extend beyond an assessment of traditional health status indicators like death, disease and disability. A population health approach establishes indicators related to mental and social well-being, quality of life, life satisfaction, income, employment and working conditions, education and other factors known to influence health. I like this! I fell in love with this before and I am in love with it still. This is a good time for an emoticon. How about we explore what is good and what is right because to me that sounds good and sounds right and sounds like something we should stick to. Creating solutions to those challenges is a good place to start. That’s what innovation looks like to me. P.S. If you connect with this, and you feel like it, sign up and follow me or share within your network, if you choose. Numbers give me credibility, credibility may lead to resources, partnerships and support. Those may lead to a change, organically grown grassroots change.