Three friends approach a wide river leading to a waterfall. All of a sudden, the cries of a small child in the water pierce the still air. He is flailing his arms while struggling to stay afloat, but he’s fast approaching the waterfall. Soon other children could also be seen struggling in the water. The friends jump in to rescue the kids. One by one they bring them to safety. They’re successful and their spirits are buoyed by the gratitude from the kids. Soon they realise that the number of children struggling isn’t going down. They look upstream and see more kids. They get back to work, doubling and tripling their efforts. Two of them focus on the kids drowning right away. After a while they’re exhausted. They look up to see their friend swimming away from them upstream, helping kids along the way. In despair they scream, “Hey! Where are you going! Come back. There are more kids to save.”
The friend replies, “I know. I’m going to stop whoever or whatever is throwing these children in the water!”
Helpless situationThis is a story that best describes the future of healthcare: prevention. In an era where hospitals boast of possessing hi-tech equipment, operating rooms and specialists, it is worthwhile to reflect that most often the patients’ biggest complaints are that they have to wait too long in hospitals or that the treatment is very expensive .Very often the healthcare system itself takes a toll on their health. Hospitals, however, are helpless as they have to treat many patients at any given time with the best of facilities to save them, and that is expensive. Who is to blame?
What we need in a paradigm shift of focus. There are five factors that determine the health of an individual: genes, behaviour, medical care, social environment, and physical environment. The latter two are more powerful drivers of wellness than medical care.
Struggling in a sea of pills and bills, we overlook the everyday forces that shape our health. Asthma can start in the air around us; heart diseases, diabetes, hypertension, anxiety can arise partly from our busy schedules, stressful work condition, poor food choices and even the way our neighbourhood is designed. Unfair policies and unequal opportunities disrupt both mental and physical health. We need to see that health begins in our everyday lives, in the places we live, work, eat, play and travel.
Environment mattersPreserving and promoting wellness hardly garners the attention that the curative aspect of health enjoys. We fixate on the disease, forgetting why it arose in the first place. Was it due to the patient’s work or home? Not so long ago, interacting with patients in their homes /communities was an obvious part of doctoring. Now it’s only an afterthought. That is ironical because the effectiveness of a treatment relies in the context of the patients’ social and physical environment. In a landmark report, the World Health Organisation (WHO) articulated this dilemma: “Why treat people only to send them back to the conditions that made them sick in the first place?”
Medical care accounts for only about 10 per cent of the variation in healthcare outcome, i.e. by doctors and hospitals. The rest 90 per cent is on the choices we make or those handed to us by our policy makers — where we live, what we eat, where we work.
The need of the hour is to transform our high-cost sick care system into a high-value healthcare system. We need to collaborate with communities, disciplines and approaches outside medicine and prescribe not just a chemical remedy but tackle sickness at its source.
There are pioneers working towards this goal. We must together work towards that goal where wellness is for all, not just medical care.
Let us swim against the current, upstream, to a fair tomorrow.
(The writer is a student of M.S. Ramaiah Medical College)
