Elevating Kids' Health Well Beyond Medicine

I hear too often that health care is so complicated that we will never be able to fix it. In my opinion, the solution is simple, and getting it right requires all of us to look beyond paying for more and more medical care and to invest wisely in what actually creates health. Our nation’s healthcare system is broken and straining under a payment structure designed to deliver as much medical care as possible, not to promote health. The fix is simple: summon the collective will to change the perverse incentives that stand in our way. I said simple, not easy.

A Simple Prescription

I have a simple prescription to fix American healthcare: 

• Understand what health is. 
• Pay for health. 
• Start with children. 

Understand what health is. Medical care accounts for less than 20% of health. Better addressing the more impactful drivers of health such as food security, safe housing, education, and more will produce better results, reduce expenditures and improve health.

Pay for health. Reimbursing providers and hospitals for the health they create, rather than the volume and complexity of services they deliver, will align the incentives of the health system with those of the patient 

Start with children. Focusing on children, when prevention and care is less expensive and more effective, ensures that the next generation of adults will be healthier. A healthier society means a healthier economy.

Overwhelming evidence demonstrates that health behaviors are set in childhood and remain fairly fixed. Childhood is when small interventions can make big differences. Research by Nobel Prize-winning economist James Heckman showed that if we change simple health behaviors by age 5, those behaviors are passed to the next generation, at no cost and with no further effort. He compared two groups of preschoolers, one of which received simple health behavior education, primary care, and a daily healthy snack. Decades later, this group continues to have markedly lower rates of diabetes, half the level of obesity, higher graduation rates and higher median income. If we start early, we change the entire trajectory of health for the individual and for society, at very little cost. 

Well Beyond Medicine – Strengthening Communities

By keeping children well in the first place, we head off the chronic diseases that burden so many adults and increase healthcare spending, including diabetes, cardiovascular disease, obesity, and cancer. Fostering whole child health and starting with these simple solutions is how we get there:  

• Approach health at the population level and use data to more effectively improve and coordinate care that has traditionally been siloed
• Address the social determinants of health — the 80% of what creates health outside the hospital and healthcare provider walls
• Engage committed partners from across healthcare — providers, payers, and community-based organizations
• Integrate physical and mental/behavioral health care 
• Prioritize the health of mothers and babies, since poor nutrition and early adverse experiences can damage health into the next generation
• Bring healthcare to where children live and learn, such as through school-based health centers 
• Work with local and state governments to incentivize healthy food providers (grocers, farmer’s markets, etc.) to serve areas where healthy food is scarce, and create safer, healthier neighborhoods
• Engaging business and philanthropic partners to power technology aspects of population health initiatives, such as Nemours web-based Reading BrightStart! Preschool Reading Screener and other literacy resources we use in 38 states

Health Through Equity. There can be no health without health equity. The deep and long-term consequences for disadvantaged individuals and people of color in our society is at the core of our nation’s poor health and is unacceptable. We can begin with what we can directly control, by addressing inequities in access to and delivery of care. We can build on this by focusing on the social determinants of health in those who need help the most. We must start with routinely measuring the health of our patients across race, gender, education, and socioeconomics.

The Role of Health Care Leaders 

It is paramount that we view our jobs as creating health, not just treating illness. Children’s hospitals and health systems must evolve to become not just care providers to children but stewards of children’s health, because even the highest quality of medical care will not create health.

To effect federal policy change, Nemours collaborates with the Children’s Hospital Association to bring patients’ stories directly to their members of Congress. Collaborating with other children’s hospitals is yielding invaluable advances in medical care, and in addressing the social determinants and tackling health disparities.

Conclusion

Elevating Humanity, HLTH’s 2023 theme, is what we can expect when we actively create health, eliminate disparities and improve how we provide health care. 

More than any other factor, our nation’s future depends on whether we get children’s health right today, so tomorrow’s adults are healthier, happier and more productive than ever. The solution is simple, and we must lead the way. Elevating kids’ health by going well beyond medicine, is the first step toward elevating humanity.

R. Lawrence Moss, MD, FACS, FAAP is president and CEO of Nemours Children’s Health, based in Jacksonville, FL. He is also a pediatric surgeon, biomedical researcher, educator and author of Finding Health by Looking in the Right Place: How Understanding What Actually Creates Health Can Fix U.S. Healthcare.