Public health rhetoric has changed in the last ten years. We now know that health care does not equal health and 80 percent of how healthy we are depends on social determinants like local environment, education, diet, and culture. This knowledge has led to a shift in focus for population health from access and insurance to health disparities and their root causes.
At the Robert Wood Johnson Foundation (RWJF) board meeting last spring I reviewed the County Health Rankings. These rankings look at 34 indicators based on the most comparable, reliable, reproducible, and accessible data. The data is well-vetted, applicable and usable for all communities.
To my dismay, my home city of Nashville, Tennessee, in Davidson County was ranked 13th out of Tennessee’s 95 counties, and the state overall is one of the unhealthiest states in the union: 42nd of 50.
I was immediately struck by the irony.
The Nashville health care industry contributes $30 billion locally and $70 billion globally produced by more than 250 health care companies operating in Nashville and working on a multistate, national, and international basis. Nashville is also home to more than 300 professional service firms working in the “peri-healthcare” space. Of these corporations, over 260 of them are members of the Nashville Health Care Council, a unique non-profit organization holding together a coalition of the most powerful names in healthcare.
We consider Nashville one of the healthcare capitols of the world, an up-and-coming “it” city. But unfortunately it is also an example of how health care does not equal health.
The TIME Magazine article that appeared in March 2014 alluded to the problem. The author extolled the success of our higher education, music, and health industries while also noting that 72% of metro public school children suffer from economic disadvantage. We have very successful large businesses—specifically large healthcare providers—but these healthcare dollars do not always translate to health.
The truth is that choosing to “live well” is often a function of your social determinants. Making good choices like getting exercise, eating healthful food, using preventative care, and avoiding harmful habits like smoking is difficult if more immediate problems threaten your livelihood, such as economic instability, unclean or unsafe housing, unreliable transportation, and social isolation. We are blessed with much affluence in Nashville, but a significant percentage of our population struggles with these issues daily.
Our zip codes are more powerful predictors of life expectancy than our genetics not because of the availability of walking trails, but because of the income level, job security, education, and support structure of the community. Only a secure and safe community can then turn its attention to offering healthy choices. However, for much of our country and for Nashville, making the healthy choice the easy choice means first addressing these underlying insecurities.
Fixing these basic problems is not inexpensive, but the price of inaction is absolutely unaffordable. Without change we will lose billions of dollars over the next decade in deteriorating health and a less productive work force, making it more expensive to live, raise families, and for employers to build or even continue to operate in some markets. Inaction will result in economic stagnation, rising unemployment and a rising cost of healthcare.
While I am personally concerned about my home city, this issue is a national one. The success and health of our country—made up of all of our cities and counties—depends on the health of our workforce and citizenry. We cannot continue to ignore that heart disease is the number one killer in this country and for most people it will be caused by environmental factors, not genetics.
The cost of healthcare will never decrease if we maintain our current health habits. For the first time in history the life expectancy of our children is potentially lower than our own. This is simply unacceptable.
Around the country public health champions do incredible work every day. But this isn’t a problem for only a few. In my home city I am calling for a collaborative to attack the large problems from multiple angles and focus resources on the neediest areas.
We can make changes that will save the city millions of dollars over the next decade and ensure our children do not face a societal structure that threatens their health. Frankly, given the state of our healthcare system and economy, we have no choice.
Join me. Look up your County Health Ranking. Ask what your community is doing, and consider how you can contribute. The secret to this type of change is that it can happen on the individual and local level, and it is the most impactful thing we can do to ensure the future success of our country.
Doctor and Senator Bill Frist is both a nationally recognized heart and lung transplant surgeon and former U.S. Senate Majority Leader.
