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Traditionally, a year-end message is an occasion for reflection. As I approach retirement from a long career as a general pediatrician, I have additional cause to reflect on the state of health in the US, and the role that ICH can play in fostering healthier communities.
The US healthcare system is in an existential crisis. (Of course, I said exactly the same thing forty years ago, so take my prognostications with a large grain of salt...) Even the term “healthcare system” seems problematic: There has never seemed to be anything “systematic” about the American health care system, unless you count the systematic diversion of public, health-related funds to private corporate entities (and bloated “non-profit” systems).
Policy makers and journalists still talk about the great faux paradox of the American healthcare system: We spend substantially more per capita on health care than any other country, but we consistently have the poorest outcomes compared to other similarly developed nations. But of course, there really is no paradox: Countries that spend less on healthcare while achieving better outcomes expend their resources far more wisely, by such measures as feeding, housing and educating their populations. In other words, everyone else seems to have figured out that policies aimed at fostering healthy communities are more effective at fostering individual health than pouring more money into a profoundly dysfunctional healthcare system.
The pandemic dramatically exacerbated the status quo ante. The precipitous rise in behavioral health conditions; critical workforce deficiencies; the toxic politicization of public health measures like vaccines: these are just a few examples of increased stress to the “system”. In addition, the sharp decrease in average US life expectancy driven by COVID’s toll, notably unequal in its effect on historically vulnerable communities, masks a concerning, underlying secular trend: Overall US life expectancy is trending down, even controlling for the pandemic’s toll. And this toll is not spread equitably, but rather disproportionately affects historically disadvantaged populations.
Having said all this, I guess I can’t just say “happy holidays” and wrap things up!
What does all this mean for ICH in the coming year? Perhaps surprisingly, I see tremendous opportunity. ICH understands that policies to strengthen communities hold the key to both community and individual health. Work to foster healthy communities plays to ICH’s many strengths. We will continue and expand on ICH’s critical work to date, while also launching a strategic planning process to assure that we maximize our impact. (More to come re strategic planning…)
In many ways, this has been yet another in a run of several trying years.
But as we look forward to 2024, I want to recognize and celebrate the tremendous and positive work done by everyone at ICH. It is work that matters. It is work that makes a difference. And it is precisely the work called for in our challenging times.
Wishing all wonderful holidays, and a happy and healthy New Year,
Greg
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