All of Us

The Need For New Ways Of Engaging Americans On Health Improvement: The Low Usage Challenge

by Mike Critelli

MakeUsWell Network’s founders feared that the single-minded focus on virus containment would cause all other necessary health improvement initiatives to be delayed or abandoned.

Americans have more healthcare, wellness programs, and medications available than ever, and a reasonably good health improvement blueprint on how to improve health. For many life-threatening conditions like cancer, we have the world’s best care. 

But our results are terrible. Our life expectancy has dropped back to 1996 levels. Why?

Americans always underutilize preventive care, fail to manage chronic diseases, and delay treatment for more acute conditions. The pandemic made overall health worse.

Self-insured employers spend significant money for healthcare and wellness programs, but do not realize their intended benefits. Timely usage of available programs is disappointing. 


These are the most common reasons we do not take the opportunities to engage with health improvement programs:

  • Lack of time and convenient healthcare access

  • Cost barriers

  • Many illnesses and diseases lack symptoms

  • Fear of acknowledging illnesses and diseases

  • Distrust of government and the healthcare system

  • Wellness, chronic disease management, and other health improvement that require major changes in daily life habits and established social relationships

  • Mental health conditions that deprive us of the energy to cope with other chronic diseases

Governments, self-insured employers, insurance companies, and many non-profit service providers focus heavily on access and cost obstacles. But they underestimate the role the remaining obstacles play in underutilization and do a poor job of overcoming these barriers.

We have had great successes in public health campaigns from which we can draw lessons in changing population behaviors:

  • Tobacco usage has declined from over 50% of American adults in the 1960’s to around 20% today.

  • Fatalities resulting from individuals driving while alcohol-impaired have dropped 56% since 1982.

But health-improving behaviors often require major changes in daily habits and routines that most Americans are not prepared to make.

  • Mindless eating occurs because unhealthy food is conveniently available.

  • Less healthy foods can be consumed more efficiently. 

  • Altering routines to consume smaller portions and healthier foods and beverages is complex.

Untreated or poorly controlled depression and other mental health disorders compromise the ability to implement health improvements. 

  • 25-50% of Americans who have serious and untreated mental health conditions. Reason: the stigma attached to acknowledgment of mental health issues. 

  • Mental health treatment is foundational for treating every other kind of chronic disease. 

  • Untreated behavioral health disorders deprive patients of the energy to follow any other treatment plans.

What do we need to do differently?

We need to use software and augmented Artificial General Intelligence (AGI) analytics to improve what we communicate and what we do to improve health. We must:

  • Price healthcare services and wellness incentives properly to signal and provide incentives for health improvement behaviors.

  • Prioritize limited resources to improve housing, public safety, affordable, attractive, and conveniently accessible healthy foods and beverages, and other social health determinants.

  • Segment populations the same way that successful consumer product and service marketing has successfully done. We have to meet people where they are.

  • Make healthy life decisions easier than unhealthy ones.

  • Eliminate the multiple sources of fear and stigmatization from talking openly about health issues, particularly mental health.

  • Bring people together to help one another, not exploit and criticize others who are experiencing difficult times.