Place for Health Promotion in Health Care

 In Preventive Medicine Column

The Place for Health in Health Care

Despite the haze of perennial sleep deprivation that characterizes medical residency training, I noticed during mine that 8 out of 10 hospital beds were filled by miserably sick people that never needed to be so sick in the first place, and that our best efforts, in common with the King’s horses and men, would never again make truly whole. Hospitals battled the ravages of disease; we were not in the business of making health.

But that didn’t seem entirely right, even then. Hospitals were, after all, part of what we have long called our “health care” system. I couldn’t swat away the irritating idea that somewhere, among all the catheters and cannulae, and between the raucous resuscitations (successful and otherwise), there was something more to do about actual health. I went on, accordingly, to a second residency in Preventive Medicine, and have done all I can ever since to keep people out of hospital beds in the first place.

The reality, though, is that a lot of people do wind up in hospital beds; I have been there myself. And along with all of those who are there supine, there are the upright in their diverse multitudes: nurses, doctors, and PAs; technicians, dietitians, and therapists; social workers, chefs, and administrators. There are nearly 6,000 hospitals in the United States, employing more than 5 million of the health care sector’s total workforce of some 12.2 million. These are sizable chunks of the U.S. workforce, population, and economy- and in a sector that is growing.

Historically, hospitals have been conceived, from their very construction to their by-laws, for the accommodation of providers, not patients. Your medical record, home to all manner of intimacy, has belonged to staff- and not to you. The final hours of potential communion with a loved one in the ICU were subordinate to visiting hour rules often little better than arbitrary.

Not that staff have been on a picnic, either. The hours are long; the stress is high; the amenities, questionable. The smells are noxious, the sounds mostly dissonant, and the food generally dubious at best.

So it is these fortresses in the disease wars have done far less than they might to propagate health, and maybe even conspired against it for patients and providers alike. But that can change.

One can imagine kinder, gentler hospitals. One can imagine a lobby like that of a hotel, scented with flowers, not formaldehyde. One can imagine the soothing tones of piano, or guitar. One can imagine an ICU designed with a wrap-around, outer corridor providing families private access to a loved-one’s bed, allowing for visitation any time, day or night.

One can imagine the eviction of fast-food franchises, and junk food vending. One can imagine that these repositories of all the devastation tobacco wreaks would establish smoke-free campuses; sponsor smoking prevention programs; and offer state-of-the art smoking cessation support as a matter of routine. Tobacco belongs entirely in history’s ashtray of dreadful ideas, and hospitals might help speed it on its way.

One can imagine a devotion to actual culinary excellence, so that food, too, is medicine- for patients and staff alike. Better still, the hospital cafeteria might showcase family-friendly meals of high nutritional standards, and hand out laminated recipe cards along with encouragement to, by all means, try this at home. Perhaps those cafeterias might extend as well to a take-out service, so that weary staff at the end of a long day or night have recourse to something fresh, and wholesome, and nurturing.

One can imagine, in other words, health promoting hospitals, and ideally, as prominences in a cultural landscape of health promotion. In principle, this is nothing but obvious. In practice, though, and historical context, putting hospitals and health promotion in a common sentence flirts with oxymoron.

There are exceptions, and I am privileged to work in one. Griffin Hospital, in Derby, Connecticut, headquarters for Planetree and the patient-centered care movement, demonstrates much of what’s possible. Even here, though, more can be done.

The International Network of Health Promoting Hospitals and Health Services is devoted to narrowing the gap between principle and practice, and to converting the luminous examples of possibility into the industry standards that prevail. They are not new to the fray; they convene their 24th annual conference this June on the Yale University campus. I am honored to be a participant.

Though the most visible landmarks in our health care system, hospitals have historically had little to do with the promotion of health. Deeply caring people around the world are collaborating to change that. There is a bounty of years to add to lives, and a bounty of life to add to years, if we can establish health, and not just the treatment of disease, as the priority of a system that bears the name.

-fin Dr. David L. Katz;www.davidkatzmd.com; author, Disease Proof; founder, True Health Initiative

Dr. David L. Katz
DAVID L. KATZ MD, MPH, FACPM, FACP, FACLM, is the founding director (1998) of Yale University's Yale-Griffin Prevention Research Center, and current President of the American College of Lifestyle Medicine. He earned his BA degree from Dartmouth College (1984); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He completed sequential residency training in Internal Medicine, and Preventive Medicine/Public Health. He is a two-time diplomate of the American Board of Internal Medicine, and a board-certified specialist in Preventive Medicine/Public Health. He has received two Honorary Doctorates. Dr. Katz has published roughly 200 scientific articles and textbook chapters, and 15 books to date, including multiple editions of leading textbooks in both Preventive Medicine, and nutrition. Recognized globally for expertise in nutrition, weight management and the prevention of chronic disease, he has a social media following of well over half a million. In 2015, Dr. Katz established the True Health Initiative to help convert what we know about lifestyle as medicine into what we do about it, in the service of adding years to lives and life to years around the globe.
Recent Posts