Despite significant advances over the past 30 years, health systems across the globe struggle to deliver high quality, affordable care to people who need it the most. We are living longer, healthier and more productive lives thanks to new drugs, new treatments and new techniques. Yet we are confronted by a pandemic of chronic conditions, including cancer, diabetes, heart disease and lung disease that are costly to the system.
The threats to our health have changed, but the health systems designed to protect us have not. Across the world they are creaking under the growing strain. The traditional model - hospital-centric, doctor-dependent, providing episodic, reactive, disjointed care in which the patient is a passive recipient - is tottering.
We need a different approach, one that recognizes the new challenges we face - that 60 percent of global deaths are now caused by chronic conditions, according to the World Health Organization. We need to target individual health interventions and lifestyle advice based on personal data to those who will benefit most. For too long, access to health care has meant access to the same care, regardless of the individual's specific needs. By taking a broader population perspective and using data and insights to drive care that is measurable, embedded in communities, team-based, and involves continuous, integrated, preventative treatment that includes the patient and public as partner, we can improve health outcomes and lower costs.
Employers are taking an increasing interest in these initiatives. There are many levels at which employers can engage. Employer involvement in community health can include addressing direct health costs by creating health benefits programs, improving worksite wellness and focusing on health care. Starbucks spends more on health insurance for its employees than it does on coffee.
Employers can also go beyond direct health costs to include incentive approaches for employee well-being, and collaboration with other local businesses to improve health. According to a National Business Coalition of Health case study, Pitney Bowes, for example, has on-site medical clinics in the U.S. which provide free healthcare access to roughly 20 percent of its employees.
Lastly, large global employers can make a commitment to support community-based health programs. GE, with more than 300,000 employees worldwide, has launched the HealthyCities Leadership Academy which will see up to 10 communities across the United States awarded funding to train community and business leaders to improve the health of working families.
In Cincinnati, GE joined forces with other employers and local organizations in 2009 to launch a healthyCommunities initiative focused on improving primary care, sharing patient information among health providers, providing better treatment of children with asthma and adults with diabetes, encouraging public reporting of quality measures and implementing payment incentives. After three years, the results showed a statistically significant reduction in absence from work - equivalent to 7,000 fewer employees calling in sick per year. Emergency department visits were reduced, hospital admissions of children with asthma were cut and diabetes patients experienced fewer complications. A similar GE program around obesity management has begun in Houston with other large employers in the area including the Texas Medical Center with a goal of reducing obesity rates by 20 percent by 2020.
At a conference on population health held in London in July, jointly hosted by Imperial College and GE, experts from around the world assessed the potential health, social and economic gains from such interventions. The group agreed urgent work is required to determine which interventions will deliver the most cost effective solutions. Evidence from cases studies in a report to be presented at the third World Innovation Summit for Health (WISH) in Doha in November shows what can be achieved. In Gesundes Kinzigtal, a joint venture between doctors and a health management company covering 31,000 residents in Kinzigtal, southwest Germany, patients are encouraged to join dance and yoga classes, support is offered to help workers stay healthy and targeted care is provided to people with chronic conditions based on an assessment of their risks. The results show the overall health of the population has improved, death rates have fallen and there was a cost saving of 16.9 per cent compared with other regions.
In southern Sweden, the Jonkoping County Council, which provides health services for its population of 340,000 in partnership with local government, runs a "passion for life" program aimed at reducing isolation among elderly people, family centers providing support to parents and children and "health dialogues" for people of all ages to promote improved lifestyles. Jonkoping has reduced the rate of hospital admissions among the elderly from behavior such as smoking in Sweden.
These are the green shoots of the population health movement. Nurturing them requires policymakers to understand the health needs of their populations, set clear goals for improvement and take action across all determinants of health including social, economic, physical and behavioral. It also requires political will. Support is necessary not just from policy makers, but large employers around the world must collaborate on population health. In order to deliver on community-based programs, employers need to take a multi-faceted approach, engage stakeholders involved in decision making and hold them accountable for outcomes. Only by working together in these ways, however, can we hope to make sustainable change.
Lord Darzi is a surgeon and director of the Institute of Global Health Innovation at Imperial College London.
Sue Siegel is Chief Executive Officer of GE Ventures and healthymagination.
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