When I was an infectious diseases specialist, most of the patients I saw were hospital inpatients but I also saw a few outpatients. They came to see me because of weeks or months of symptoms that their doctors couldn’t figure out and were often worried that they had a mysterious infection that was hard to diagnose. All of these patients had real symptoms – they were extremely tired, had headaches, muscle pains and sore throats. They generally arrived with stacks of medical records – numerous lab tests and notes from other doctors. I also noticed that many of them had serious “real life” problems – bad marriages, difficulties at work, housing problems, sick relatives and more. Perhaps they really did have an infection that I couldn’t find but I also began to wonder if their symptoms were caused by the stress.
My intuition was that many of these patients would benefit from speaking with a social worker, marriage counselor, psychologist, an expert in finding affordable housing or a financial planner. Unfortunately, these services were not part of our health care system. I suspected that many of my patients would get better if we were able to treat the whole patient, not just the symptoms.
Lauren Taylor, co-author of “The American Health Care Paradox”, expanded on how psychosocial issues influence health in a talk at the Mayo Clinic Transform 2014 conference. She said we need to distinguish between health and health care to explain why the US spends more money on healthcare than other countries but does not get better results. The evidence shows that only about 20% of health is determined by health care. Another 20% or so of health is due to genetics and the remaining 60% is due to social, behavioral and environmental factors. The social services spending in the US is very small compared to other countries. The ratio of health care spending to social services spending in the US is worse than most other industrialized countries.
A recent podcast from the Robert Wood Johnson Foundation was devoted to the importance of social services in health. Research shows that people who have more stress in their lives are less able to focus on their health. It makes sense that it is hard to pay attention to taking your medications if you don’t have money to heat your house. Clinicians need to look more broadly at why a patient is not following the recommendations of their health team. For example, an elderly person who misses appointments may be not be able to get a ride or may not have money for public transportation. SImilarly, almost half of seniors in the US report feeling lonely and studies have shown that people who are lonely are less healthy and at greater risk of dying.
We need to think more (and spend more) on social services. To quote Alexandra Drane, co-founder of Eliza Corporation and another speaker on the podcast:
When life goes wrong, health goes wrong…helping someone survive a divorce is just as important as helping someone with their diabetes.
Health is not the same thing as health care. Health is much broader — health is life.