Many Americans think that the U.S healthcare system is the best in the world, but this is incorrect. This is because many Americans essentially misunderstand what is meant by healthcare. The mistake lies in equating healthcare with medical care. The U.S has one of the best medical systems in the world. It does not have one of the best healthcare systems. What's the difference?
At its most basic level, a good medical system is supposed to be the method of last resort. You are only supposed to go to a medical practitioner (doctor, physician, general practitioner) once you have already become ill. There are some exceptions, general check-ups or cosmetic surgery for example, but ultimately you are only supposed to see a doctor once you are sick. A good healthcare system is intended to prevent you from getting sick in the first place. This means that a medical system is only a small part of a greater healthcare system.
The American misapprehension of the full scope of healthcare started when U.S public health officials began working out of hospitals. For many years, public health professionals have worked within hospital settings, which began the assumption that public health is a part of medical care and not the other way around. In other parts of the world, public health professionals exist outside the hospital, which is something the U.S is trying to reestablish today.
Public health is not just immunizations, flu shots for the young and elderly, or free cancer screenings or mammograms. The most liberal definition of public health includes almost every sector of our community. Transportation, education, work environments, agriculture, housing, unemployment, living conditions, water sanitation — almost everything falls under the field of public health. Actually one of the greatest public health successes in the State of Florida were seat belt laws. This is why many Americans are shocked to find out that the more educated you are, the healthier you become. Or that the healthiest cities in the world all have excellent public transportation systems. In fact transportation and education may have stronger associations with good health than modern medicine. Many get confused by this fact. Probably because of the long held belief that the world population is booming and people are living longer because of the modern medical system. However, in 1976 Thomas McKeown indicated in his book The Modern Rise of Population, that populations started rising and death rates started falling in the early 1800s, which is way before the invention of modern medicine.
While I was studying in London, I was also a visiting researcher for the London School of Hygiene and Tropical Medicine’s Transport and Health Group (Group). During my time there, Group was not only doing public policy research for government departments, such as Transport for London and local government municipalities within the Greater London boroughs, but they were also doing studies on metropolises across the world (London, Sao Paulo, Tokyo, Paris, Mexico City, etc.), and attempting to determine the relative healthiness of each city. At the time of publication of this article, I don’t believe many of the studies I was working on are published, so the results are currently confidential. But if I learned one thing from Group, it was this: there is a very strong link between transportation and health. The experts at Group knew this fact so well, that many government departments trusted them to examine how transportation policy was effecting community health. For example, Group discovered that London’s 20 mile per hour zones actually worked better in richer communities than poorer communities. Also, lighting up streets more, or keeping streets darker, didn’t affect crime at all.
So why do I bring this up? This attribution error is driving bad policy on public medical expenditures in the U.S. In 2014, over $840 billion, or about 24% of the total U.S budget, was spent on not covering every American with comprehensive health insurance. The United Kingdom on the other hand, spent £119 billion, or about 18% of the UK’s budget, on covering every single UK citizen through their National Health Service (NHS). But the NHS is more than just a medical service, it’s a public health service.
In short, because the UK has a better understanding of the impact public health makes, is why: the UK spends less money then the U.S on healthcare (roughly 9.1% of their GDP), the British have a longer life expectancy then Americans, and every UK citizen is covered. The Queen’s government uses public health to make sure more people stay healthy and do not need to pursue medical care. While in the U.S, because of our misunderstanding of healthcare, we continue to throw money at our medical services and wonder why nothing is changing. We continue to spend more money, our population keeps growing, and our life expectancy is decreasing.
Therefore, next time there is a national discussion of healthcare, do more than just to talk to your doctor. You should talk to a local public health professional, a health insurance provider, a head of a teacher’s union, a university professor, a local grocery store manager, and a social housing expert, because all of these people impact healthcare in our communities. Your doctor is only a component of your medical care, not the whole healthcare system. Good healthcare allows you to access a good doctor in a good medical system. But a good healthcare system also allows everyone to have health insurance, comprehensive pharmaceutical care, and protection within your community to prevent you from getting sick in the first place. Germany’s healthcare system is famous for providing bellydancing and massages absolutely free as part of the German healthcare system. And while this initially seems like an example of big government or ‘the nanny state’, with a good understanding of healthcare, this can properly be viewed as a symptom of good public health in Germany.
An exclusive view of medical care as health policy is too narrow an approach to provide for the well-being of citizens. Healthcare is a smarter and better policy framework. Hopefully US policymakers will look to other developed countries, such as Germany and the UK, and see the merit in their approaches. Their citizens deserve it. So this election season, when the topic of healthcare comes up, let’s actually discuss healthcare. Is your healthcare plan working well for you? Do you feel the sanitation standards at your local grocery store are high enough? Do local kindergarten facilities have the resources they need to take care of the young in our communities? Does your child’s school have updated textbooks? My point being, let’s talk about you when you’re not in your doctor’s office, so we can keep your family healthy and not have to see your doctor for a while.