Why health care should start long before you reach the hospital

The issues that determine your health go way beyond seeing your doctor.

MICHAEL DOWLING: If you want to improve health, you have to deal with more than just the provision of medical care. So a lot of what medical care gets blamed for or what we call the health system, the hospitals, the docs what we get blamed for are things that we don't have direct responsibility for. In the U.S. we have very, very high mortality, higher than other parts of the world there are lots of reasons for this. For example, death from gunshot wounds is included in the mortality stats. Yet, people who work in health care are not the people who actually kill people with guns. Sometimes, these statistics get all warped. That doesn't mean we shouldn't be involved. That doesn't mean we shouldn't be a catalyst, that we shouldn't be an influencer, that we shouldn't actually be out there in the communities doing things.

Now if you get sick and you come to a hospital, yeah, we can take care of you. But the issues that determine your health go way, way beyond just the provision of medical care. It has to do with lifestyle. It has to do with social circumstance. It has to do with environment, your family situation, where you live. If you're living in a very, very good neighborhood there's a lot of research done on this with all of the facilities that you would have in any top, middle-class, upper-middle-class neighborhood, you will live years longer than the person who lives in a very, very poor area, in general. So if I want to improve your health, I've got to make sure that I have doctors, and nurses, et cetera to provide medical care to you. But I've also got to figure out how to work on all of these other things.

How do I, for example, make sure that there is not lead in the house that you live in or in the apartment building. We had kids living in homes and it still goes on in many of the buildings in New York City and elsewhere where the radiators in the homes were painted with lead paint or lead pipes. Now I can have the doctor go to that apartment every month and treat that kid. But unless I change the paint, or change the pipe, or get rid of the radiator, or cover up the radiator, having a doctor go there every month doesn't necessarily overall improve health.

So I know somebody in the last two days that was at the hospital, had an occurrence in one of our hospitals, goes home. Our hospital sent a nutritionist to the home. That nutritionist sat down with that person for a couple of hours, explained to them how they should be eating. That person, there was a weight issue not substantial but there was a weight issue, there was a high blood pressure issue so they explained diet. They then offered to come to the home and teach the person how to cook those foods that would be more appropriate to improve health. That's how we improve health. The hospital did its thing. But if you don't follow up and do those other things, that person will be back in the hospital again.

  • The average American spends about 24 hours a year at the doctor's office.
  • What you do the other 364 days a year mostly determines your health.
  • Michael Dowling discusses Northwell's focus on environmental, social, economic and other social determinants of health.


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