Here’s a game you can play. At your next dinner party or discussion with friends at a bar, start a conversation about how to make Americans healthier. You can talk about anything you wish: the fact that health in America is getting worse, that the opioid epidemic has led to a life expectancy decline, or that firearms are a health problem. When you start the conversation, start a timer.
The object of the game: to see how long it takes for someone in the conversation to use the word “healthcare” interchangeably with health.
We have played this game many times and are confident in saying that the end of the game will come within 5 minutes. It never takes longer for some to inadvertently say “healthcare” when they mean “health.”
The reader of The Public’s Health knows that health and healthcare are very different things. Health is a desired state of wellbeing that allows us to do what we want to do, that has us living full, rich lives, achieving whatever potential we wish to achieve. Healthcare is the system that aims to restore us to health when we get sick. It is what we Americans spend enormous amounts of money on, often at the expense of health.
We argue that the conflation of health and healthcare is not without consequence. In fact, we’d say this conflation fundamentally affects the health of our country. When we think that health and healthcare are synonymous, we do not stop to ask ourselves: how are we doing in investing in early childhood education, parks and recreation, prevention of suicide and substance use, gender equity, and clean air, examples of forces that ultimately create health? If we do not ask how we are doing in these areas, if we do not invest in them, this underinvestment results in our collective poor health.
The conflation of health and healthcare has resulted in a one-sided, indefatigable investment in healthcare. Yet this focus on curative medicine is not improving our health. We should be focusing on health, on keeping us healthy to begin with. And to do that we need to better tell the stories of how health is generated. We should change what we talk about when we talk about health, one dinner party, one bar discussion at a time.
Warmly,
Michael Stein & Sandro Galea