Family Physician Calls Nation To Shift The Focus Of Healthcare Reform Debates

085eed1adc2af27ea2c75c96a14ec751-huge-6dToday on the blog, a family physician dedicated to the elimination of health inequities, explains why we need to shift the focus of the healthcare reform discussion.

By Anthony Fleg, M.D.

Like many Americans, including many of my colleagues in healthcare, I’m concerned about the future of healthcare reform. There’s little question that the proposed American Health Care Act (AHCA) currently under consideration would have a tremendous impact on the most vulnerable Americans - a reality that not only troubles me as a family physician, but should also give pause to individuals from across the country and across the political spectrum.

Let’s take a step back and look at the bigger picture. As the White House works to get a law passed, the conversation, almost entirely, will be about health insurance and the healthcare system, ACA vs. AHCA. But it’s our failure to invest in systems of health, not healthcare, that have us lagging behind other nations of the industrialized world. We need to shift the conversation from improving healthcare to improving health.

Health begins with the foods we eat, the education we receive, the neighborhoods we live in, the jobs available to us, and the health of the natural environment. These social determinants of health far outweigh healthcare and health insurance in their importance to the overall wellbeing of our communities and nation. For the one in three children and two in three adults in New Mexico who are overweight, access to the best healthcare and best health insurance will only serve to treat the downstream consequences of their weight. Investing in better health infrastructure – healthier food systems, more walking- and biking-friendly communities, improved early childhood and public school education – is much more important for improving health than health insurance.

Second, the major health disparities in this country are rooted in much larger unaddressed societal inequities. Some groups of Americans can expect to live into their 80s, while for many marginalized communities, making it to your 60s is beating the odds. Take, for example, a person who lives in poverty, amidst violence, and who has few prospects for employment. Giving that person the best health insurance and access to the best healthcare will do little to change their prospects for health. While hard to quantify, best estimates are that only 5-10% of inequities in health (e.g., those which are unjust, unfair, and preventable) are due to inequities in healthcare. Inequities in health, the reasons that some groups live sicker and die younger, have very little to do with what healthcare or what health insurance people receive. Beyond anything we debate about health insurance, if we are interested in creating a healthier nation, we need to put attention and resources into addressing social determinants of health and societal inequities.

I hope the national dialogue moves far beyond the AHCA and begins to focus on creating a more health-promoting and equitable society. With that as our focus, creating health policy for a healthier America, instead of for political agendas and tax cuts, becomes the mission.  That’s a mission worth pursuing.

Anthony Fleg, M.D., M.P.H., is a family physician in New Mexico dedicated to working for the elimination of health inequities. He helps coordinate a love-funded, people-powered partnership called the Native Health Initiative, which he credits with keeping him grounded through his years of medical training and practice. Email:

Posted by Sonya Collins on May 25, 2017 11:56 AM America/New_York
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