A poll fielded several years ago by the Stanford Center on Longevity found that more than 3 out of 4 Americans aspired to be centenarians. Unfortunately, as research suggests, they are likely to spend two of those 10 decades unhealthy: in and out of hospitals, battling chronic conditions, racking up crippling medical bills. Knowing that, would they have chosen differently?
Americans’ fixation on longevity may be wishful thinking, but more importantly it’s at odds with how most of us choose to live, eat, care for ourselves and care for our communities. And this gap between dream and reality, between want and will, continues to widen and take a costly human and financial toll. Nearly half of Americans (45%) suffer from one or more chronic diseases. U.S. life expectancy has dropped more significantly than peer countries. And healthcare costs are rising faster in the U.S. than anywhere in the world.
In both tragic and instructive ways, the COVID-19 pandemic forced a reckoning with this harsh reality, presenting an urgent opportunity to recalibrate our approach to personal and public health. Rather than measure success by lifespan, we should instead measure it by healthspan, or the number of years individuals get to enjoy life healthily and independently.
What would it mean to shift our focus in this way? What would and should we do differently?
To start with, we would evolve our healthcare delivery models and mindsets from the ingrained approach of seeking care only when people are sick, to proactively working toward keeping people well. Not only are most individuals programmed to wait until things go wrong to seek care—adding to avoidable emergency department visits and the skyrocketing cost of care—but we all know that our fee-for-service healthcare system reinforces this by incentivizing and reimbursing providers for generating more visits and procedures, rather than for keeping people healthy and achieving measurable outcomes.
At Crossover Health, where we oversee and deliver clinical care, we’re incentivized to keep people well—rather than to simply ward off and treat illness. We anchor our approach with the mantra that “not being sick is not good enough,” which means that care teams design coordinated and accountable care plans to support personal health goals and promote healthy habits and self-care. To be well, both today and down the stretch—requires proactive attention to how individuals live, their life choices and their daily habits.
Yes, that means promoting annual wellness visits (something the vast majority of Americans don’t do) and getting regular preventive screenings. But when we flip the sick care model on its head, we’re immediately confronted with a stunning fact: Only around 20% of what affects an individual’s health outcomes is directly influenced by traditional medical care. Up to 80% has nothing to do with what happens in a physician’s office, including about 50% or so which is driven by behavioral factors—things like tobacco and alcohol use, diet, sleep and exercise that are to some extent under our control. A comprehensive and proactive approach to well care focuses on identifying and addressing these upstream behaviors that, left unchecked, will only pave the way to costly disease.
This leaves about 30% of America’s health outcomes at the mercy of social and environmental determinants that affect some communities disproportionately to others: everything from food access and housing security to water and air quality. In one stark example of how your ZIP code may be more predictive of healthspan than your genetic code, an analysis of over 3,000 U.S. counties in 2020 found that a person living in a county with high pollution levels, measured by the presence of fine particulate matter, was 15% more likely to die from COVID-19 than someone in a region with one unit less of pollution.
So, for those of us who’d like to achieve a better healthspan and help others do the same, what can we do differently today and tomorrow? The answer comes down to making better choices, both as individuals, health professionals and members of our communities. That doesn’t just mean encouraging eating more vegetables, doing yoga and counting steps. It means ensuring health providers establish relationships with their patients to help set and meet personal health goals—not just facilitate and charge for repeated sick visits. It also means people taking a stand to address the widening health inequities by voting for local and federal lawmakers who support clean air legislation, affordable housing, initiatives targeting food deserts, and more. In this way, the pandemic has taught us the important lesson that we are all connected and interdependent—and that public health is personal and personal health is public.
As a country and healthcare system, we find ourselves at a critical juncture. One path leads us to more preventable disease, spiraling healthcare costs and widening disparities while we dream of living forever. The other leads to healthier lives today for more Americans at a cost we can afford—which just might get us to 100.