He who has health has hopeHe who has health has hopeHe who has hope has everythingHe who has hope has everythingThe value proposition for HealthThe value proposition for Health

John R. Lumpkin, MD, MPH

Robert Wood Johnson Foundation

What is Health?What is Health?

HEALTHHEALTH

• WHO– HEALTH IS A STATE OF COMPLETE

PHYSICAL, MENTAL AND SOCIAL WELL-BEING AND NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY

– HEALTH IS A STATE OF WELL-BEING AND THE CAPABILITY TO FUNCTION IN THE FACE OF CHANGING CIRCUMSTANCES

HealthHealth

• Curative Services (Health Care)

• Preventive Services (Public Health)

Health and Health CareHealth and Health CareDoes it work?Does it work?

19001900

• LEADING CAUSE OF DEATH– PNEUMONIA– TUBERCULOSIS– DYSENTARY

• LIFE EXPECTANCY 49 YEARS

• 4-5% GNP EXPENDED ON HEALTH CARE

19601960

• LEADING CAUSES OF DEATH– HEART DISEASE– CANCER – STROKE

• LIFE EXPECTANCY 65 YEARS

• 4-5% GNP ON HEALTH CARE

20002000

• LEADING CAUSES OF DEATH– HEART DISEASE – CANCER– STROKE

• LIFE EXPECTANT ABOUT 75 YEARS

• 15% OF GNP ON HEALTH CARE

• $1.7 Trillion dollars

Is there a relationship withIs there a relationship withEconomic Development? Economic Development?

Are there economic Costs for Poor Are there economic Costs for Poor Health?Health?

• Smoking– Increase Absenteeism– Increase Insurance Costs– Increase Maintenance and cleaning costs– Decrease productivity

• PUD – $5 Billion Health Care Costs– $1 Billion Productivity Costs

• Nosocomial Post Surgical Infections– $5,155 in follow up costs– ($1,773 for controls)

Health Care Expenditures result Health Care Expenditures result in Economic Development?in Economic Development?

• WHO Sachs Report– 10% increase in life expectancy

– 0.3 to 0.4% rise in growth rate

• Families USA– $1 Million Decrease in Medicaid

• $3 Million in lost Business

• $1.2 Million in wages

• 37 jobs

• Health Systems impacts on their communities

Relationship of Health to Relationship of Health to Economic Growth?Economic Growth?

EconomicGrowth

Health Care Costs

Relationship of Health Care Costs Relationship of Health Care Costs to Economic Development?to Economic Development?

Rocket Science?Rocket Science?

Cell Science Rocket Science

Brent Cell, 2000

Health and Health Care Health and Health Care Complex SystemsComplex Systems

Health is ComplexHealth is Complex

Approach and rationaleApproach and rationaleA guide to thinking about the determinants of population health

NOTES: Adapted from Dahlgren and Whitehead, 1991. The dotted lines denote interaction effects between and among the various levels of health determinants (Worthman, 1999).

Over the life span

Living and working conditions may include:

• Psychosocial factors• Employment status and occupational factors • Socioeconomic status (income, education, occupation)• The natural and builtc environments• Public health services• Health care services

IOM - 2002

Good Health Care is complexGood Health Care is complex

Informed,ActivatedPatient

ProductiveInteractions

Prepared,ProactivePractice Team

Functional and Clinical Outcomes

DeliverySystemDesign

Decision Support

ClinicalInformation

Systems

Self-Management

Support

Health System

Resources and Policies

Community

Health Care Organization

Chronic Care Model

Informed Activated Patient Results from Informed Activated Patient Results from Education, Decision Support (Care Education, Decision Support (Care

Management) and Active InvolvementManagement) and Active Involvement

Informed,ActivatedPatient

ProductiveInteractions

Prepared,ProactivePractice Team

Self-Management Support

Decision

Support

The success or failure of any government in The success or failure of any government in the final analysis must be measured by the the final analysis must be measured by the well-being of its citizens. Nothing can be well-being of its citizens. Nothing can be more important to a state than its public more important to a state than its public

health; the states paramount concern should health; the states paramount concern should be the health of its people.be the health of its people.

- Franklin Delanor Roosevelt

(1932)

The value proposition for The value proposition for Health and Health Care?Health and Health Care?

Health Health Care

Economic Health

Community

WHAT A DIFFERENCE TWO WHAT A DIFFERENCE TWO YEARS MAKE!YEARS MAKE!

2001: $127b. Surplus

2003: $401b. Deficit

WHAT HAPPENS BY 2014WHAT HAPPENS BY 2014IF WE DO NOTHING?IF WE DO NOTHING?

• With reasonable assumptions on:– Tax cuts– AMT– Growth of discretionary spending– Medicare

• Deficit = almost $700b. or >$1t.

• National debt = $5.7t.

ELIMINATING DEFICIT BY 2014: ELIMINATING DEFICIT BY 2014: WHAT WOULD IT TAKE?WHAT WOULD IT TAKE?

• Assume :– No cuts in defense– Minimize tax increases– Elimination of unified budget deficit

ALL THESE ACTIONS ALL THESE ACTIONS COMBINED WOULD BE COMBINED WOULD BE

INSUFFICIENT:INSUFFICIENT:– Turning all education, housing, urban development,

manpower, environment, and law enforcement programs back to states

– Eliminating or privatizing 80 commercial subsidy programs

– Undertaking significant fraud and abuse initiatives

– Ending manned space flight

– Ending earmarks for local highway construction

– Slowing growth of NIH spending

– Capping other discretionary spending

The next century will be dominated by economic rivalry between trading blocs,

in Europe, North America, along the Pacific Rim, and in the Caribbean Basin. In this new order, winners and losers will

be determined by the quality of a country's infrastructure, the stability of

its economy, and the healthhealth and education of its workers.

John Chancellor

He who has health has hopeHe who has health has hopeHe who has hope has everything.He who has hope has everything.