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Opinion: Health care alone can’t solve all health problems

Opinion: Health care alone can’t solve all health problems

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It’s time for health care providers and systems to admit it: health care is not the answer that will address our multifaceted health problems.

Tylenol may be a good treatment for a headache, but a headache is not caused by lack of Tylenol. That is the best analogy I’ve heard that explains why health care access is not the sole solution to health disparities.

It’s a simple analogy, but sometimes simplicity is what we are missing. Like Tylenol, health care may treat a health problem, but health problems are not truly caused by the lack of health care.

This is not to say that health care is not important when someone is sick. Obviously, it is.

However, research over decades shows that the health care that someone receives only accounts for about 10% to 20% of that individual’s health status.

This is not meant to devalue the amazing work done by our health care workforce. The intent is to call attention to the fact that being a health are practitioner shouldn’t begin and end at the bedside.

We must also be concerned about the social determinants of health that impact the health of communities, often in disparate and unexpected ways.

Socioeconomics, education, early childhood development, environment, systemic discrimination and implicit bias all are major contributors to poor health we observe in underrepresented communities.

No other factor seems to have as strong an impact on health as one’s income. The line of correlation is straight as an arrow.

Simply put, on average, the more money you make, the healthier you are. This holds true at every point on the chart. Those of higher socioeconomic position have better health than families in the middle, who have better health than families of lower socioeconomic position.

The relationship between education and health is similar. With each educational level achieved extending through college, improved health follows.

Interestingly, there does not seem to be any similar correlation with increases in health literacy. The early childhood period provides a critical window in which exposure to certain social and economic conditions can have adverse — or protective — effects on health into the adult years. It has even been shown that these childhood experiences, good or bad, can have an impact on the health of generations to follow.

The environment in which someone lives and works also plays a major role in shaping health. A neighborhood void of sidewalks, green spaces and grocers makes the doctor-recommended, “healthy eating and exercise” quite unrealistic for many.

Finally, the impact systemic racism and implicit bias have on health cannot be overlooked. Discriminatory mortgage lending practices of the not-so-distant past created cycles that continue to channel Blacks and Hispanics into neighborhoods that promote unhealthy lifestyle choices, low-paying jobs and underperforming schools, all of which contribute to health disparities.

Although unintentional, the cumulative effect of implicit bias on the part of well-intended health care providers results in the unequal treatment of underrepresented groups within the health care system.

The aggregate impact of these social determinants of health far surpasses that of the medical care received by residents of our communities.

It is incumbent on health care institutions to use their power, influence and resources to change the way we think of health.

It is clear that thinking of health as simply the absence of disease is ineffective. In the same way our health care institutions advocated on the steps of the capital to expand Medicaid, we need health care leaders to advocate for policy changes that will close gaps related to income, improve access to healthy food, increase educational attainment and educate the health care workforce on the negative impacts of unconscious bias.

Despite having the best health care workforce and medical technologies in the world, our country’s health outcomes lag behind those achieved by our peers. Changes in our approach are long overdue if we genuinely want different outcomes.

Dr. Jabraan S. Pasha, MD, FACP, RDMS, is assistant dean of student affairs and associate professor of internal medicine at the University of Oklahoma School of Community Medicine and a member of the Tulsa World Community Advisory Board. Opinion pieces by board members appear in this space most weeks.

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Dr. Jabraan S. Pasha, MD, FACP, RDMS, is assistant dean of student affairs and associate professor of internal medicine at the University of Oklahoma School of Community Medicine and a member of the Tulsa World Community Advisory Board. Opinion pieces by board members appear in this space most weeks.

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