In what does health consist? This is a basic question for each of us, individually, but also as a community. Within the larger health care debate is the question of the future health of the nation. President Donald Trump's budget for 2018 calls for $610 billion in cuts to Medicaid and cuts in disability programs by $72 billion. What does this mean? What would its effect be? How would our health be served?
Health and wellness is something innate and inherent in us, but it must also be supported from outside of us by our parents and community. Like a seed, growth is deeply in our nature, but it must be cultivated and nurtured in a wholesome environment. Our current health care policy has become a victim of ideological battles removed from its human, individual face in real people. Our current market-based model of health care is moving more to a "personal responsibility" model— with health savings accounts, private insurance and market-based solutions. This model stands on individual choices as a consumer, in isolation from others, and in isolation from the community in which one lives. This market-based, individualistic, consumerist model has been encroaching on us for the past 30 years, but is really coming to a breaking point this year in our current health care debate.
There is another model of health care, and that is a public health model. Public health is about the health of the public. Public health sees health as a whole — whole people, whole communities in an healthy, thriving environment. A public health model is evidence-based, looking at health as an investment in our future by making wise choices in policy, research and economic investment. Public health takes a wide view of the whole — the health of the individual in the context of his community, education, clean air, clean water, healthy foods, safe, clean neighborhoods- all these contribute to the health or lack of health in each of us. All this sounds obvious and self-evident , but we have to realize that this vision of health as a whole is what is under attack in our current health care debate.
For example, the Childrens Health Insurance Program (CHIP) is coming up for reauthorization by September 30, just a few weeks away. This is likely to be a proxy debate between the "Repeal and Replace" Republicans and the Obamacare Democrats. But the real debate will be what kind of health care do we deserve? What is the healthiest model of health care? Can we do better than what currently passes for health care? In other words, our current health care dysfunction could be an opportunity to build a robust, grassroots public health model of health care in place of our current unhealthy mess.
As a pediatrician I see every day that children are the health of our future. There is a great deal of exciting research data that shows that health, defined in the broadest sense possible, as physical, emotional, economic and intellectual health, is largely determined in the first five years of life. So the trajectory of health throughout life is largely set early. I saw a bumper sticker that put it succinctly, "A happy childhood lasts a lifetime." Unfortunately, the reverse is also true; deprivation, neglect and poverty also lead to poor health later on. This is not determinism, but how the body as a whole imbeds the health of its environment. We have an opportunity to get our children off to a bright start in life if we consider a public health model that sees the seeds of our health, as a nation, in giving all, but especially all children the best, most complete start in life. This is easy to do, will save millions in future treatment and will allow us to refocus on what health really is. The alternative we are heading towards is healthcare as a luxury item, with every man, woman and child for themselves. We can do better.
John F. Irwin, Baltimore
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