by Dr. Ben Danielson
In a clinic that serves a broadly diverse group of kids, a high proportion from low income backgrounds, I’ve learned a fair amount about the factors that influence health. Unfortunately, today’s healthcare system is off target. It is more prepared to treat illnesses once they’ve gotten really bad than it is prepared to catch illnesses in their earliest forms; let alone prevent illness. The bulk of our healthcare resources are directed far ‘downstream’ from the primary sources of health. As a result, our healthcare system basically spends more than any other country and has some of the worst health outcomes in the developed world.
Every person who experiences those ‘downstream’ illnesses deserve quality treatment. But, in my opinion, we also need to put more effort toward reaching upstream. The payback in long term cost savings as well as the improved quality of life for so many people, makes that argument plain enough. Best Starts for Kids Initiative (King County Proposition No. 1) will achieve these aims of higher lifelong quality of life and will save money. Especially considering what we know about the influencers that reside upstream.
The upstream factors influencing health are not big surprises, although it is a little surprising how strongly the evidence proves their role in health. The list includes things like: poverty, stressful experiences early in life, lack of educational attainment, structural racism, access to healthy food, and, interestingly, the well-being of your neighbors. Do any statistical analysis you want with these factors and you’ll find that, the worse they are the worse any illness will be. And I mean any illness: hypertension, heart attacks, depression, anxiety, diabetes, cancer, and on and on. It is rare in medical science to find such striking connections between cause and effect. It is reaffirming to know any grandmother in my community would agree with this evidence.
Knowing what we know about these fundamental factors, a few compelling concepts stand out. First is the importance of acting early. This means screening for these factors early on in a child’s life and, providing services before the seeds of illness can take root. Our continuing research and attention need to focus on building on promising strategies.
Second is the importance of focusing on the bigger impact factors. Education is related to other factors and it can be directly impacted. Missed opportunity for learning early in life is one reason big education gaps persist later in life between races and between income levels. A good education often means less poverty, resources to help manage stressful experiences, and better access to healthy foods.
Another lesson learned in our clinic is that important progress can only happen if some basic needs are met first. For many families facing stressful experiences like homelessness, meeting those immediate needs will provide the beginnings of stability and will synergize other longer term efforts.
I’m a community pediatrician, yet the evidence regarding a neighborhood’s impact on an individual’s health surprises even me. This makes me realize that pediatrics is about community health as much as it is about treating individual kids. This idea is at the heart of being a good community partner; being part of the mortar that holds communities together, and advocating for safe streets, access to healthy food, access to healthy activities.
Now, if you think all of this information is interesting but it doesn’t apply to you, think again. For starters, one way or another, you will help pay for the illness around you. An unhealthy member of society relies on more services that are paid for by your taxes. That same unhealthy person isn’t as able to help pay taxes. It’s a double cost to you. With smart investments in lifelong well-being you reap the benefits financially. But maybe more importantly, evidence shows that your personal health is strongly influenced by the health of people around you. Your family’s health is, and will be, influenced by the health of your neighbors. Remarkably, this is true even if you are in a comfortable income bracket.
Using good evidence, paying extra attention to early childhood, investing in early learning, supporting community resilience; these are the tenets of effectively improving health and these are the tenets of Best Starts For Kids. The evidence and value prospect are very sound, even if the philosophy of the levy proposal is a bit untraditional. It focuses on using a host of cost-effective tools to promote lifelong health rather than focus on one single effort. This is important, because the solutions to our health challenges do not lie in singular silver bullets, they rely on coordinated efforts that weave together multiple evidence-driven foundations for lifelong health. It’s clear that the traditional approach to health is ineffective and expensive. Better lifelong health and productivity require new ways of investing in our future . I think the untraditional strategy in this levy is a welcome departure from a status-quo approach.
As a community physician I am very pleasantly surprised to find a levy proposal that so thoroughly aligns with all that I’ve learned about truly helping people be well. A rigorous data-driven methodology and a respectful embrace of community wisdom will help keep Best Starts For Kids on track. I embrace this breath-of-fresh-air approach to funding as a hopeful sign that our society is ready to make smarter investments in our shared future.
Dr. Ben Danielson is a physician at the Odessa Brown Clinic