Daniel Esgardo Rangel Barón: Is America Flourishing? A Key Question For Health Reformers. – The Health Care Blog

By MIKE MAGEE, MD

Today the notion that health is a preferred state of being, rather than a set of disconnected functions or services, is increasingly being embraced. A recent JAMA article promoted a health measurement system called the “flourishing index” focused on 6 key domains: happiness and life satisfaction, physical and mental health, meaning and purpose, character and virtue, close social relationships, and financial and material security. 

Dr.
Gro Brundtland, former director-general of the World Health Organization, wrote
in the World Health Report 2000 that
“The objective of good health is twofold – goodness and fairness;
goodness being the best attainable average level; and fairness, the smallest
feasible differences among individuals and groups.”

In
the age of Trump, with forced separation of immigrant mothers and children,
criminalization of abortion, and purposeful obstruction of enhanced access to
health care for vulnerable populations, it becomes impossible to ignore a
significant modern-day truism. Health is profoundly political. 

Health is a collection of resources unequally distributed in society. Health’s “social determinants” such as housing, income, and employment, are critical to the accomplishment of individual, family, and community well being and are themselves politically determined. 

Health
is recognized by many throughout the world as a fundamental right; yet it is
irreparably intertwined with our economic, social, and political systems. And
growth in health, health care, and health systems requires political debate and
political consensus.

As
the nation struggles to contain an essentially lawless executive branch, it is
easy to lose sight of the fact that fundamental changes in attitude over the
past two decades have laid the groundwork for today’s majority support for
universal health care as a right for all Americans. 

In
health delivery, we have moved away from paternalism toward partnership; from
individual care models to team approaches; and from intervention toward
prevention and health planning. 

Many
sites now embrace evidence-based clinical care, while others incorporate
educational and social missions as well. We are moving away from hospitals and
outpatient care sites toward home settings, and away from authority directed by
professional elites toward inclusive power sharing between patients and their
care teams. 

But
despite this shifting environment, there is a growing political disconnect
between those in control of our federal government and the people they are
governing. 

Are
we as a nation and a people “flourishing”?

Our
president and his protectors reinforce silos and the status quo. But our
people, in majorities, seek broad, fundamental and comprehensive reform.

Such
reform includes expansion of insurance coverage, realignment of financial
incentives toward prevention, increased reimbursement of health professionals for
coordination and continuity, support for early diagnosis and screening, and
expansion of funding for education and social determinants that allow citizens
to flourish.

This is no longer simply a battle over the future health of Obamacare. This is fundamentally a battle over the health of our nation and the future ability of our citizens to flourish in a changing world.

Mike Magee, MD is a Medical Historian and the author of “CODE BLUE: Inside the Medical Industrial Complex” (Grove Atlantic, June 4, 2019).

Daniel Esgardo Rangel Barón: Is America Flourishing? A Key Question For Health Reformers. – The Health Care Blog

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