Tom Bartol is an Advanced Practice Registered Nurse at Richmond Area Health Center, HealthReach Community Health Centers, Richmond, Me.
The author has disclosed that he has no financial relationships related to this article.
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Our current healthcare system does not give us a good return on the dollar. Think about this: Imagine you bought a new appliance or computer and later find out someone else bought the same item for half the price. What if the item was a better, higher-quality model for half the price? Seeing someone else getting a much better deal on the same purchase would not sit well, yet in the United States, this is happening in our healthcare system. We pay two to three times the amount per person for our healthcare than almost any other country in the world. Based on data from the Organization for Economic Cooperation and Development, we spend over $8,200 per person per year on healthcare in the United States. This compares to $4,445 in Canada, $3,422 in the United Kingdom, and $3,019 in Italy.1
Return on investment
We pay more, but are we getting more for our money? Is the higher cost due to superior healthcare in this country? The World Health Organization ranks the United States at 37th in healthcare performance, right between Costa Rica and Slovenia, while Italy ranks 2nd, the United Kingdom 18th, and Canada 30th.2
Average life expectancy is another measure of health. In the United States, average life expectancy in 2013 was 79.6 years, ranking us 42nd in the world.3 This compares to an average life expectancy of 80.7 in the United Kingdom, 81 in Canada, and 82.4 years in Italy–countries that pay much less for healthcare.4
We are spending more and getting much less for our healthcare dollars. Healthcare expenditures in the United States increased by $1 trillion over the past decade.5 The average annual premium for employer-based health insurance has increased from approximately $6,000 dollars in 2000 to nearly $16,000 per year.6 This type of healthcare system is not sustainable.
The underlying problem
It is time to incorporate a low-tech solution into our high-tech healthcare system. An article published in JAMA identified lifestyle as the cause of about half of the deaths in the United States each year—roughly 1 million deaths. Smoking, poor diet, and physical inactivity caused the majority of these deaths. The authors concluded that, “Poor diet and physical inactivity may soon overtake tobacco as the leading cause of death.”7
High cholesterol, hypertension, and diabetes are not caused by a medication deficiency. Yet traditionally, healthcare in this country has focused on using medications to treat numbers, be it blood pressure (BP), cholesterol, or blood glucose. While these numbers are important, they are often symptoms of an underlying problem, not the problem itself. Diabetes, hypertension, heart disease, and even cancer are often the symptoms or the results of an unhealthy lifestyle. Rather than simply lowering the cholesterol level or BP, we need to focus on what is causing them to increase. Disregarding the underlying causes and treating only risk factors is similar to mopping up the floor around an overflowing sink instead of turning off the faucet.
Numerous studies have shown us that lifestyle change is a solution. The National Cancer Institute notes that physical activity can reduce the incidence of colon cancer by 30% to 40% and breast cancer by 20% to 80%.8 In a recent study in Germany, over 23,000 people were followed for nearly 8 years to see if four healthy lifestyle factors made a difference in reducing chronic diseases.9 The four healthy lifestyle factors were: never smoking; body mass index less than 30 (that is, not obese); at least 3.5 hours of physical activity per week; and simple, healthy dietary principals, including a high intake of fruits, vegetables, and whole grains as well as low meat consumption.
The study found a reduction in diabetes of 93%, myocardial infarction reduced by 81%, stroke reduced by 50%, and cancer reduced by 36%. We do not have any medications or high-tech treatments that give us these kinds of results. Simply maintaining one of these healthy lifestyles (not being obese) resulted in a 67% cumulative reduction in these chronic diseases.9
For the past 3 years at my community health center, we have been helping patients make a difference through lifestyle changes. Using simple strategies, motivation, and affirmation, we can help our patients achieve lifestyle changes. In those 3 1/2 years, approximately 1,000 patients lost over 12,000 lb (5,443.1 kg) collectively. More importantly, these people overcame personal challenges and are living healthier and feeling better. Let me share a few examples:
- A gentleman in his 70s, whom I have been seeing for years for hypertension, was finally able to get it under control with four different medications as well as one medication for his high cholesterol. With hypertension and high cholesterol, his risks were significant for heart disease or stroke. Over the past year, he lost 63 lb (28.6 kg) and has gone from five different medications to just one.
- Two years ago, a 32-year-old woman weighed over 270 lb (122.5 kg) and had BP readings over 160/100. She tried various medications for her BP and, at one point, was on three different medications. She made a choice to make lifestyle changes, is actively working on life challenges, has lost 35 lb (15.9 kg), and her BP is now normal at 118/78 without medications.
- Another patient in his late 40s with diabetes, hypertension, high cholesterol, and heart disease has lost 34 lb (15.4 kg) since last May and has been able to stop three of his medications.
This is real healthcare reform. This is the way to improve health and lower the cost of healthcare. A healthy lifestyle can change both healthcare costs and practices. Since inception of this healthy lifestyle program, the total number of medications I have prescribed to patients has dropped by 45% while the number of diagnostic tests I have ordered has dropped by 64%. I have been stopping more medications for chronic diseases than I start because patients have chosen healthy living over medications. I have stopped three chronic medications for every new one I have started within the past year.
Spreading a healthy lifestyle
When patients are given a choice in their care, for example, choosing to make lifestyle changes versus taking medications to treat (or prevent) chronic disease, many will choose lifestyle changes. When asked if they would like to try to stop some of the medications they take and make lifestyle changes instead, many choose lifestyle changes. I have found that the possibility of stopping medications has been a huge motivator for patients. Many patients would rather take less or no medications. Patients, our healthcare consumers, need a choice. Patients need and deserve a perspective; they deserve to be part of their healthcare decision making. They need strategies and someone who listens, someone who gives them what I like to call a “relationship of hope.” This is not healthcare reform; this is healthcare transformation—a transformation through healthy living.
Healthy lifestyle is contagious. With a greater emphasis on healthy lifestyles, on simple strategies to improve health, on building relationships of hope with patients, healthcare can be transformed. Healthcare providers need to do more “dancing” and less “wrestling” with patients. It may be faster to give medications to treat the numbers or the symptoms, but then the healthcare system will need to keep mopping up around an overflowing sink.
Nurse practitioners are well prepared to build these relationships, to “dance” with our patients, and transform our healthcare system. It is time for patients and healthcare providers to work together, focusing not only on the symptoms but on the causes of health problems as well. Healthy living is the best revenge for our ailing healthcare system.
Lippincott Williams & Wilkins.