Health is only partly about health care services. That is the major point of a perspective essay What Business Are We In? The Emergence of Health as the Business of Health Care (New England Journal of Medicine). Drs. Asch and Volpp compare the health care industry to Kodak, who did not understand that their true business was in making images, not in making film cameras. Likewise, the health care industry may see its product as procedures, visits, and surgeries – rather than seeing the product as “health”.
If medical services were the gateway to health, then people in countries with socialized medicine would have similar health at all income levels. This is not the case: the groundbreaking work on social-economic status and health was first done in Great Britain. Asch and Volpp mention these studies, known as the Whitehall studies, in the essay to emphasize the point that medical care does not by itself create health.
Asch and Volpp call for doctors, hospitals, and health systems to shift to a broader range of approaches. The new focus would make clear that the goal is health, not simply delivery of medical services.
My own work is going in this direction, connecting health problems with more of the environmental and social factors that play a role. For example, emerging research is pointing to a connection between stability of housing and health status. It’s possible that the best “treatment” for a low-income patient suffering depression is a furnished apartment. By contrast, an employed person suffering depression may improve when they finally get the list of who will be laid off. Uncertainty in the workplace is linked to higher incidence of depression and higher blood pressure, among other things.
The more that we can focus on the real determinants of health, the better equipped we will be to improve health.