How can we fix global healthcare?

When I was a physician-in-training, at a hospital in one of the poorest sections of Boston, I first met “Patient Ruth”. She appeared at the admitting station late on a winter night, homeless and helpless. Her feet were swollen, she wore flimsy house shoes, and raw leg ulcers made walking painful. She’d been to the emergency room many times, and we gave her the usual treatment – a few hours in a warm bed, some antibiotics, a decent meal. The next morning she limped back to the same problems she had before: no home, no job, lousy food, no family or friends to come to her aid. We were not equipped to protect her from her harsh world outside the hospital, which was destroying her health and shortening her life.

There are millions of Patient Ruths, and we must address the many systems outside the hospital walls if we want to help them. While health will always be linked to healthcare, it also depends on jobs, family and community; on economic and social opportunity; on prevention as well as treatment.

The Robert Wood Foundation (RWJF) has worked for more than four decades to address some of the most difficult challenges to health, such as tobacco use, end-of-life care, childhood obesity and access to high quality, affordable medical care. In 2014 we embarked on our biggest effort yet – to build a comprehensive culture of health by addressing the many socio-economic threats to health: poor housing, inequality, lack of education, unhealthy food options, trauma and a paucity of outdoor spaces for play and physical activity. We are working towards a culture of healthy, where cities, towns and neighbourhoods are designed to maximize healthy behaviour in children and adults; where businesses can rely on the health of their workers; militaries can perform at their highest level; and where the trillions of dollars spent on healthcare goes way down.

Building such a culture requires broad-reaching partnerships and system-level change. In addition to traditional policy and business approaches, it will require an understanding of a dynamic new world of big data, social networking and creative innovation. And it requires harnessing the power of the internet, mobile devices and social media. Popular sentiments, social movements and political revolutions have been sparked by grassroots movements based on social networking, and if we want to improve the health of nations we must also harness these technologies, or risk having our voices unheard, or ignored.

But most of all, we must join forces. Non-profits, governments, businesses and community leaders must connect their actions to others. We must all step outside our comfort zones and support ideas with transformative potential, take risks on less proven approaches, and open ourselves to exploring new solutions. Some examples:

• In a unique arrangement, RWJF agreed to fund an independent count to determine whether 16 of the nation’s largest food companies fulfilled their pledge to reduce the calories in their products. In January 2014 we announced that the companies exceeded their goal, selling 6.4 trillion fewer calories in the US between 2007 and 2012.
• Boston-based Health Leads, an RWJF grantee, helps healthcare providers “prescribe” basic resources to low-income patients, such as food, housing, electricity, heating, even job training. Trained college students man a member clinic’s waiting room, where they help fill the prescriptions by connecting patients to community services and public benefits. Health Leads currently collaborates with 20 clinical partners in six cities and this year will deploy some 1,000 advocates to connect 14,500 patients and their families to the resources they need to be healthy.
• Last year President Obama announced a five-year initiative to help young men of colour in the US reach their full potential in school, work and life, called My Brother’s Keeper. The White House is working with 10 foundations, including RWJF, that are collectively investing at least $200 million, and there will be additional investments from the business community.
• Apple’s ResearchKit, announced in March, combines open source software, big data, medicine and the internet of things to advance both population and personal health goals by enabling people to use mobile devices to collect their personal health data and share it with scientists. RWJF funded the development of two apps that allow patients to easily and securely share their data, giving far more people the opportunity to participate in medical research.

Some 40 years ago, renowned German design theorist Horst Rittel first defined wicked problems – those global challenges that are so complicated and continuously changing that the solutions are neither clear nor stable. There are few problems more wicked than the myriad global threats to health. Only through complex, systemic change, with all hands on deck, can there be solutions. As Martin Luther King Jr. once said, “Change does not roll in on the wheels of inevitability, but comes through continuous struggle.”

Author: Risa Lavizzo-Mourey, President and CEO, the Robert Wood Johnson Foundation

Image: A boy wears a mask before receiving an Influenza A (H1N1) vaccine at a hospital in Taipei November 9, 2009. REUTERS/Nicky Loh