WELLNESS OR ILLNESS:
POLICY POTENTIAL OR FAILURE
Should we aim to get rid of illness or to create conditions that support wellness? These two policy positions point to completely different outcomes.
As someone who grew up in Australia but who spent five years living in the US, I’ve always found the US approach to health and healthcare weird. People seem to be locked into a false paradigm: that health is about being ‘treated’ to fix health ‘problems’.
We know this isn’t true. We routinely read about the relationship between the way we live and poor health outcomes. The New York Times a little while back published an article about the Declining Health Outcomes of Hispanic Immigrants as they progressively adapt to the American dream and adopt an American lifestyle. As one of the comments in response to the article notes: It’s not rocket science.
The problem of the false paradigm was reinforced for me when I read an article by Ray Fisman in Slate on the results of the first two years of A Trial in Oregon, in which a sample of people who would otherwise not have had health insurance were provided it by the state. l Their health indicators (obesity, hypertension, cholesterol levels) were found not to differ significantly from those of a control group of people without health insurance. On the basis of these results, Fisman regretfully concluded that Obamacare had failed.
If the success of health insurance is to be measured by the incidence of obesity, hypertension and high cholesterol, then the US health care system has already failed.
Health insurance is just that: Insurance. It’s like a safety net in a circus: Having a net in place doesn’t make trapeze artists better at what they do; it simply catches them if they fall. A more meaningful test of Obamacare in Oregon would have been to compare the mortality rates of those who fell seriously ill; I bet those with health insurance would survive better than those without. That’s what health insurance is about.
Anyway, I think this whole discussion misses the point of the health challenge that looms for the US, for my country and for a host of other countries facing the ageing of its baby boomer generation. Advanced countries like ours are facing financial ruin as expenditure on treating illness grows. We are never going to fix all the illness that our ageing populations face.
But there is a different way to look at this issue and, as it happens, this approach has a whole range of benefits.
Wellness: Policy Panacea
Let’s just pretend for a moment that instead of trying to avoid illness, we focussed on trying to embrace wellness. On the face of it, these are the same thing, but actually they drive a whole different set of outcomes.
Wellness is about being physically able to live a long and productive life. This is helped by living in communities where people can walk easily, where they have access to healthy food, where they can get a good dose of fresh air. So what does a walkable environment with nice places to be outside look like? What does this mean for urban design? For planning policies? For city ordinances? Suddenly there is a reason to support urban farms and local food.
Wellness is about having our spirits lifted. There is solid evidence that seeing trees and hearing birdsong each day are correlated with good mental health outcomes. So what does this mean for urban parks? How about policies supporting selection of tree species to encourage native birds to flourish. Wellness is about being connected to your community. What does this mean for transit provision to support stay-at-home parents without access to a car or who would otherwise have to pay for a car to get around? What does it mean for local government support for new parents?
Wellness is about being able to age in place. What does this mean for planning codes that encourage multi-generational occupancy? For guidelines that encourage design of houses that remain accessible for people unable to climb stairs? This has been addressed in Canada through 8-80 Cities and in the UK through the Barker Review and through such initiatives as Lifetime Homes. Recently, Lorraine Farrelly wrote about what is happening in Melbourne.
The point is that illness is about the health system; wellness is about urban planning, design and delivery. We are customers of the former and we have to decide if we can afford to do anything; we are participants in the latter and we need to decide if we can afford not to do everything.