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.

Why?

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.

2 Responses

Nice piece, Mike. I'm optimistic going forward for many reason. First, healthcare access in the US is at its highest level ever, and while Boomers and Gen X, especially, are still slow to take advantage of preventative care, millennials and Gen Z are not. Indeed, they may be the healthiest generations we have had. Family Medicine, which is all about intergenerational preventative care, continues to increase by about 7% a year. It likely would increase faster except for a slower rate of med students choosing that path, partly due to salaries. Second, after hours care continues to increase. My wife and I are part of the family med practice at UMich. They have gone mostly virtual for all visits and queries, and often you can get an "instant visit" with one of the many physicians and PAs in their network all over the state. We can also talk to a triage nurse 24/7. While Covid clogged hospitals and ERs, the growth of private urgent care centers, as well as access to vaccines and other routine testing and consultations at most drug stores, has grown exponentially and is predicted to be primary source of those activities going forward. (Elizabeth Holmes had the right idea, but the wrong technology.) Third, Obamacare finally has turned access to care into a "right of access", as it has been for most countries in the world. And while health insurance is still expensive, federal and increasingly state subsidies continue to grow. Are we still far behind most high income countries as to outcomes? Sure. But integrated IT access to all healthcare records promises to turn reminders from our smart furnace to change filters into reminders and cautions for all kinds of preventative care. Finally, we are finally seeing cures for chronic conditions through various gene and stem cell therapies. Within ten years we likely will be curing sickle cell disease, as well as B-thalassemia, and hemophilia through gene therapy. Stem cell infusions likely will reverse many other degenerative diseases. Diabetes is also on that list. We have a long way to go, but I believe the future looks bright.

Jim MacPherson

As a practicing physician, I found this article on the need for new ways to engage Americans in health improvement initiatives quite insightful. You rightly highlight the fact that despite having access to healthcare, wellness programs, and medications, we are not seeing the results we should. I also agree with the reasons mentioned in the article as to why people do not take advantage of health improvement programs. In addition to the barriers mentioned in the article, there are major systemic issues in the US healthcare system that must be addressed to improve health outcomes. For instance, the complicated nature of billing and payor models makes it difficult for patients to understand or anticipate costs related to seeking preventative care and treatment. Job insecurity and frequent layoffs have led to a generation of workers that either lacks continuous healthcare due to periods of unemployment or chooses to eschew employer-based benefits and instead pursue freelancing or self-employment. The United States has also failed to adequately increase the number of medical residency spots proportionate to the needs of an aging American population. From personal experience, the immigration process even for highly skilled workers like medical doctors is complex, lengthy and tremendously time-consuming. Many of my International Medical Graduate colleagues from Residency struggled or were unable to stay in the United States following residency because of the complicated nature of Visa sponsorship. I appreciate the suggestion in the article to use software and augmented Artificial General Intelligence (AGI) analytics to improve what we communicate and what we do to improve health. I am optimistic about the recent advances in AI and its potential to reduce charting demands in medicine, which can sometimes account for 2x the amount of face time with each patient. However, we must also address the systemic issues mentioned above to truly improve health outcomes in the United States.

Laura Leyton, MD

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

by Mike Critelli

Why?

What do we need to do differently?