Let’s Make Sure “Health” Encompasses “Care”

Risa preferred headshotFor the past several months the Robert Wood Johnson Foundation has been promoting a particular vision– of a Culture of Health in America, where everyone  has the opportunity to live the healthiest life possible, no matter their income, or where they live, or work, or play.

With  that vision in mind, geriatrician Dr. Leslie Kernisan asks an important question in her Oct 7 Health Care Blog post, “Why #CultureofHealth Doesn’t Work For Me.”  She writes: “Is promoting a Culture of Health the same as promoting a Culture of Care? As a front-line clinician, they feel very different to me.”

For physicians treating the chronically ill and patients facing the end of life, good health might seem like a pipe dream. Kernisan and some of her commenters even wonder if the phrase “Culture of Health” could be misconstrued as “blaming the victim.”

I appreciate—and am grateful for– her concern.  I am also a geriatrician, so I understand where Kernisan is coming from. I believe that care and health are two sides of the same coin. Having a system that provides care when, how, and where people need it is a crucial component of a Culture of Health.

I had a light bulb moment early in my career when I realized that we cannot properly care for the very ill unless we address the many issues that affects their health outside the clinic’s walls.  I was doing my residency in Boston when I met a woman I will always think of as “Patient Ruth.” She appeared at my hospital’s admitting station late on a winter night, homeless and helpless, and she brought the cold in with her.

Her feet were swollen; she wore flimsy house shoes and raw leg ulcers made walking painful. Her medical chart was thick; she’d been to the hospital many times before. We did for her what the hospital always did– a few hours in a warm bed, some antibiotics, a decent meal. But the rules dictated that the next morning we had to let her go, limping back to the same problems she had before: No home, no job, lousy food, cast-off clothing, no family or friends to come to her aid.

We were bit players in a system that was not equipped to protect Patient Ruth from the harshness of life outside the hospital, a harshness that was destroying her health and shortening her life. What if, instead of ushering her back into the cold, we could have asked what she needed to keep from having to come back? And then what if we linked her to those people or services? Shouldn’t that be the aim of every medical visit?

Those questions, and the answers, are intrinsic to building a Culture of Health. Ruth is never going to run a marathon, but there are things that can be done to help her find her own “healthy”. Ultimately there is no single way to cultivate health, or offer care. Only by all of us working toward a common goal, for everyone in America — be they sick or well, just born into this world or reaching the end of life — can we truly build a nation where everyone has the opportunity to achieve their optimal health.

Risa Lavizzo-Mourey is the CEO of the Robert Wood Johnson Foundation