Posted on | August 10, 2013 |
Central to the ongoing debate over the “fiscal cliff” in the United States has been a discussion of the nation’s expanding debt crisis tied mainly to long term commitments to Medicare and Social Security. Of the two, all agree that Medicare commitments, compounded by an aging population, pose the most immediate threat. However, controlling Medicare expenditures can not be viewed in isolation, but rather as part of a larger problem historically involving growth in the nation’s overall health care expenditures at a higher rate than overall inflation.
A variety of structural strategies over the past two decades, intended to control expenditures, such as the use of health maintenance organizations, have been modestly successful at best. During this same period, socioeconomic trends including an aging population, the growth of health consumerism, concern over the health impacts of global warming and environmental degradation, and the transformational impact of the Internet and new information networking capabilities have continued to impact and reshape the health care sector.
The empowerment of health consumers has been viewed by both political parties as a potentially powerful tool in reshaping the health care sector in a manner that both increases quality and controls cost. Democrats have focused on expanding health care coverage through the Affordable Care Act and on insuring a basic benefit structure. Republicans have emphasized the role of the private sector and the need for consumers to be more financially accountable for the choices that they make.
The full potential of consumer empowerment remains largely unrealized in the United States for two reasons. First, the effort to educate consumers has been sporadic and episodic. Specifically, a comprehensive basic medical science collection of integrated open source materials that are highly visual, entertaining, informative and effective at low literacy does not exist. Second, absent a broad understanding of the basics of human physiology and pathophysiology, the American public is poorly grounded and inadequately incentivized to pursue the customized strategic health planning necessary to achieve preventive health and lower the cost of disease.
Twenty five years into the consumer health revolution and with near ubiquitous access to modern mobile information technology, there remains a remarkably primitive, disjointed and ineffectual approach to consumer health education. In an age where Sal Kahn with his Kahn Academy have revolutionized high school curricula with an open access, online, direct, customized, participatory and integrated collection of high school educational offerings(1), public and private health professional organizations have offered up incomplete, unsophisticated and poorly integrated offerings that provide sporadic exposure to bits of pathophysiology, diagnostics and treatments without adequate basic science foundations.(2,3,4,5,6)
Well designed partial offerings such as those provided by the Mayo Clinic(7,8) are incomplete collections with no overarching curriculum infrastructure. Others, such as the Healthwise Patient Education Solution integrate with existing EMR’s, provide the “most accurate, up-to-date, evidence based information available”, and commit to getting “the right information to the right person at the right time.”(9) This is done well and is important in the scheme of provider-driven disease management and treatment compliance. But it is not the same as population wide basic medical science literacy and the capacity to plan forward to achieve full human potential and prospective wellness. J&J supported BabyCenter.com(10) receives high grades for capturing moms early in intra-utero child development, placing their soon to be babies on a developmental and customized dynamic time line, proactively feeding them with age appropriate developmental information and tips, and harnessing social networking to connect them to parents like them who might otherwise be isolated and alone. While the approach has great merit, and might serve as a template for lifespan planning and curricular scaffolding, it currently remains a targeted and useful resource rather than a basic science foundation.
Back in 1980, in Greenfield, MA, I ran a voluntary non-profit organization called KID-MED. It’s goal was to teach basic medical science to 3rd graders using a combination of publications, exhibits, and well-designed team teaching visits between local physicians and home room teachers in our public schools. What we learned was: 1) The basics of organic chemistry, reproductive physiology, embryology, respiration and neuroendocrinology could be taught to 3rd graders, and 2) Once basic science principles were well established, principles like healthy diets, drug avoidance, safety, smoking avoidance, and respect for oneself and for others easily followed.
As part of the Healthy Person Project, which focuses on establishing customized strategic health planning early in life, I asked a group of 350 first year college students in 2011 to chose the top 25 actions or interventions that would best allow a child, recently conceived, to achieve his or her full human potential.(10) When we analyzed the results, one message was clear. They were not prepared to logically plan for prevention in part because they lacked an integrated understanding of their own basic medical science.
So here’s my point. We are currently attempting to move from an interventional to a prevention oriented health care system. Simultaneously, we are confronting unsustainable health care expenditures and expecting health consumers to make wiser health care decisions, to prioritize (as we asked the college students to do) and best apply limited resources.
To accomplish prevention, quality outcomes and efficient use of limited resources, we must properly educate health consumers leveraging all tools available to us. Materials developed must be open source, online, and begin always with basic medical science – and not simply nomenclature and anatomy, but more importantly, physiology. Built upon a good basic medical science foundation, pathophysiology, diagnostics and treatment information have motivational context and support the ultimate goal. Which is? Customized and personalized strategic health planning, beginning before conception and extending beyond death.
The fastest road to prevention and cost control is through a properly educated consumer public.
For Health Commentary, I’m Mike Magee.
1. Kahn Academy. Cancer Lecture. 2013 http://www.khanacademy.org/science/biology/cell-division/v/cancer