Health Care System and Addressing the Determinants of Health

Joseph Pizzorno, ND, Editor in Chief; Stacie Stephenson, DC

The US population is sick and becoming sicker at all ages. For the first time ever in our history, children born today are projected to live shorter lives and suffer a heavier burden of disease than their parents. Yet we spend much more per capita on health care than any other country. Something is fundamentally wrong. America cannot be great if her people are sick and dysfunctional. In this article, we address the fundamental causes of the health care crisis and the transformational thinking and leadership required to restore our people to health.

The US Population Suffers a High, and Ever-increasing Burden of Ill Health and Disease

The numbers are clear: US children and adults are suffering an ever-increasing burden of ill health and chronic disease never before seen in our country. According to the Centers for Disease Control, considering only adults in their prime (aged 18–64 years) and only 6 chronic diseases, almost 50% suffer from 1 or more chronic diseases with a stunning 8% suffering 3 or more. Diabetes has become epidemic, increasing more than 15-fold since the senior author was in naturopathic medical school. Attention-deficit/hyperactivity disorder and autism—conditions rarely seen in the past—now affect an ever-increasing number of children. Although a medical apologist might argue we have more disease now because people are living longer, the reality is that we have substantially more disease in every age group. The current priorities and “health care” system simply are not working.

Why Is the US Population So Sick?

In an Integrative Medicine: A Clinician’s Journal (IMCJ) editorial from volume 14, issue 3 (2015), entitled “Hard to be Healthy in North America,”1   substantial research is reviewed showing how rampant nutritional deficiencies and high toxic load have become the primary causes of ill health and disease. These issues have addressed in many editorials and articles in the 16 years since the founding of IMCJ. Using only the example of diabetes, excessive sugar consumption and depletion of the trace mineral chromium have contributed to the epidemic. But far more important has been the inundation of the population with chemicals such as phthalates that block insulin receptor sites and metals such as arsenic that damage the pancreas’ ability to produce insulin. The role of these toxins—found in our air, water, food, cleaning agents, and even health and beauty aids—is fully documented in an IMCJ editorial in volume  15,  issue  4  (2016),  “Is  the  Diabetes  Epidemic Primarily Due to Toxins?”2

We Need a Health Care System

Ultimately, the only cure for the ailing health care system is to help people to be healthier. This requires fundamentally rethinking what we fund and prioritize. Key to this is changing the passive determinants of health—dietary, environmental, and social. By this, we mean making changes that do not depend on behavioral change. We are not suggesting abandoning health education or promotion of healthier individual choices. Rather, that we must change the environment to promote health rather than disease. Key examples are the research showing that food grown conventionally has suffered a 25% to 80% decrease in trace minerals. Without adequate consumption of these key nutrients, the enzyme machines that provide us life are not able to work properly. Worse, we have now contaminated the environment with chemical and metals toxins that actually poison these enzymes and cause disease.

A true health care—rather than a disease care— system addresses these foundational determinants of health. Following are some ideas on how to accomplish this.

Public Health That Promotes a Health-promoting Environment

We need to more fully embrace the promise of public health. Many years ago in an IMCJ editorial in volume 2, issue 2 (2003), “Integrative Medicine and Public Health,”3 a vision for 21st-century public health was presented. As you may know, historically, 75% of the increase in longevity is due to public health measures. Although most people think of public health as contagion control and providing health care for underserved populations, it can be so much more. We have 3 suggestions:

1. Teach and reward farmers to grow food with higher nutrient density.

2. Teach and reward farmers to decrease pesticide and herbicide contamination of food and the environment.

3. Develop, fund, and implement real health education as a major program in schools.

Nutritional deficiencies are rampant in the United States. According to hundreds of published research studies, almost the whole population is deficient in at least       1 nutrient with half the population deficient in many. Our physiology does not work if required nutrients are not available. There are several key reasons why this has become huge problem:

1. Most of the foods most commonly eaten in the United States are processed in such a way as to improve appearance and short-term taste, at the expense of nutrient content. Approximately 20% of the average person’s calories come from nutrient-empty sugar.

2. Synthetic fertilizers promote the growth of bigger food, but with seriously lower levels of nutrients. The more fertilizer used, the lower the nutrient content. So even if a person is trying to eat responsibly (i.e., real foods rather than high processed … stuff), the critical nutrients are much lower than the body needs.

3. Worse, high-phosphate fertilizers often contain high levels of the heavy metal cadmium. Not only does this then impair the absorption of critical trace mineral zinc by the foods, but this toxin poisons many systems of the body, and it is a key factor in the kidney disease epidemic, osteoporosis, cardiovascular disease (especially in women), thyroid dysfunction—the list is long.

Rather than subsidizing farming practices that produce large amounts of nutrient-deficient foods, we should either totally eliminate such subsidies or redirect them to reward nutrient density rather than food size and weight.

Many examples show how public health measures such as we suggested previously work. For example, adding iodine to salt dramatically decreased severe hypothyroidism and protected many children from intellectual impairment. Another is the 1970s measure prohibiting lead in gasoline and paint resulting in more than a 90% decrease in blood lead levels in children and adults. These are good examples of passive changes that promote health without requiring behavioral change.

Primary Care That Addresses the Primary Causes of Disease

We   need to fundamentally change how everyday health care is provided. With typically less than 10 minutes per office call, it is not surprising that pretty much most doctors can only diagnose disease and prescribe drugs to alleviate symptoms. Although sometimes this works well, such as for infections, for virtually all chronic disease, this fails. There is something seriously wrong with a health care system where 9 of the top 10 most commonly prescribed drugs only alleviate symptoms while allowing the underlying disease and it causes to proceed unimpaired. This is full addressed in an IMCJ editorial in volume 7, issue 3 (2008), “We Need Drugs, Don’t We?”4

Instead, we need primary care that focuses on helping patients understand why they are sick and how to become health. Most therapies should be agents such as nutrients that support proper (even optimal!) physiological function rather than drugs that temporarily relieve symptoms. The optimal primary care physician is an amalgamation of today’s family practice medical doctors, and modern naturopathic doctors (NDs), and broad scope chiropractors. Growing research supports this approach. The IMCJ editorial in volume 7, issue 5 (2008), “Integrative Medicine: Cost   Effectiveness?   Long-term   Health   Outcomes?”5 reviews some very compelling research. Although correlation does not prove causation, something can be learned by noting that 8 of the healthiest states license naturopathic physicians. In contrast, none of the 20 least healthy states license NDs.

Personalized Health Care Rather Than Generic Disease Care

This topic is fully addressed in the accompanying article by Dr Bland.

Health Care Reimbursement and Regulation

The adage that you get more of what is subsidized and less of what is taxed is certainly true in health care. As a business person, you know that competition results in better and less expensive products and services. However, this does not work if distorted by crony capitalism, political-activism pressure, and protectionism. Government subsidizes conventional medicine education, residencies, research, income, and others while suppressing the other health care professions that provide different, and often better, solutions.

The most important role of government is to ensure a level playing field and that health care professionals are appropriately trained and regulated. Let the consumer decide which healing art they want. All health care professionals should be licensed and paid according to their educational standards and scientific validity.

Conclusion

President Trump, you are in a remarkable place in history. Our population is sick, the “health care” system is on life support, and the costs are bankrupting our country. With your leadership, we can change the fundamental determinants of health, the only cure for the ailing health care system.

The White House Commission on Complementary and Alternative Medicine Policy (of which the senior author was a member) was created by President Clinton and US Congress and continued by President Bush to advise them on how to improve the health care system through the integration of the concepts discussed in this editorial. The report published in 2002 provided many keys that are equally valid and important today. Convening another such Commission with your appointees would be a huge help in solving this very challenging problem.

P.S. To help focus our message, we did not include the thousands of references to the peer-reviewed medical research that support our assessment and recommendations. Many of these are included in the IMCJ editorials mentioned previously.

References

1.  Pizzorno J. Hard to be healthy in North America. Integrat Med Clin J.

2015;14(3):8-13.

2.  Pizzorno J. Is the diabetes epidemic primarily due to toxins? Integrat Med Clin J. 2016;15(4):8-17.

3.  Pizzorno J. Integrative medicine and public health. Integrat Med Clin J.

2003;2(2):8-9.

4.  Pizzorno J. We need drugs, don’t we? Integrat Med Clin J. 2008;7(3):8-10.

5.  Pizzorno J. Integrative medicine: Cost effectiveness? Long-term health out- comes? Integrat Med Clin J. 2008;7(5):8-10.