Do We Need Population Health Shock Therapy?

Originally posted 10/5/2011

I just finished reading Thomas Friedman and Michael Mandelbaum’s new book That Used To Be Us: How America Fell Behind in the World It Invented and How We Can Come Back. It’s a sobering read as it assesses the U.S.’s position in the world and what we have to do to regain lost economic and social competitiveness.

Friedman and Mandelbaum focus on four areas we need to urgently address in order to avoid falling into second world status: globalization, the information technology revolution, deficits and debt, and energy demand and climate change. The authors express particular concern about our education performance, and argue that recent information about relative international test score performance should have prompted a response similar to the investments in science and technology spurred by Sputnik a generation ago. But that hasn’t happened.

I found their diagnosis compelling and sobering, so looked forward to reading their “prescription” in the final chapters. In a chapter called “Shock Therapy,” they argue that the current political paralysis is not up to these challenges and that the system calls for political shock therapy — a direct analogy to its once classic use in psychiatry — defined by the authors as a radical centrist third party.

What does this have to do with population health? I am basically an optimist, and I do believe that more attention is being paid to population health policy now than a decade ago. Friedman and Mandelbaum call themselves “frustrated optimists” – I, too, have days when I wonder whether we will be able to assemble the will and resources to show improvement in our health outcomes, including the persistent health disparities by race, education, income, geography, and gender.

In discussing this blog and the challenges of its having traction in the world of national policy debate, a wise colleague recently mused that that the intensity and frustration of current immediate challenges may numb many of us from even more distant and difficult goals. A recent New York Times op-edargued that “problems like mass joblessness and starvation can seem so daunting that we stop trying to help.” Likewise, David Brooks recently commented on the limits of empathy, observing that “empathy has become a shortcut…a way to experience delicious moral emotions without confronting the weaknesses in our nature that prevent us from actually acting upon them.” He argued that religious, military, social or philosophic codes are much more powerful and are sources of identity and joy that trump empathy alone.

The radical centrist third party Friedman and Mandelbaum suggest for their four challenges would go beyond empathy and compassion alone and would likely have an impact on population health policy, particularly given its emphasis on education as well as science and technology. But how realistic is it, and do we sit by the sidelines for it to happen? My prescription for the next decade may not be shock therapy, but I hope that population health advocates would support the following steps until something more promising or radical emerges:

  1. Be clear on our metrics for achievement and improvement, including disparity reduction.
  2. Find savings from ineffective health care spending, and reallocate them to other population health determinants through such mechanisms as IRS Community Benefit reform and ACO shared savings.
  3. Identify and enhance health promoting policies and programs in non-health care areas (Health in All PoliciesHealth Impact Assessments).
  4. Identify cross-sectoral national and local partnership models with business models and financial teeth to leverage additional resources and policies.

Are there better goals for the next decade?

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