Local health concerns

I’ve written: Who better to understand the health care challenges of a community than local delivery organizations?  Recent research by Richard Florida et al. reveals that “States with large concentrations of working class jobs had lower levels of income, GDP per capita, and well-being – pretty much everything across the board.”

Most important to health care delivery is the well-being aspect; both physical health and healthy behavior were negatively correlated in states with a large share of working class jobs.  So again, if so much of health care is based locally, why are we trying to solve its problems nationally?


Consequence of economic downturn: the growth of local

One economic downturn reality beginning to reveal itself: an emphasis on local.

Peggy Noonan in Friday’s Wall Street Journal:

Dynamism has been leached from our system for now, but not from the human brain or heart. Just as our political regeneration will happen locally, in counties and states that learn how to control themselves and demonstrate how to govern effectively in a time of limits, so will our economic regeneration. That will begin in someone’s garage, somebody’s kitchen, as it did in the case of Messrs. Jobs and Wozniak. The comeback will be from the ground up and will start with innovation. No one trusts big anymore. In the future everything will be local. That’s where the magic will be. And no amount of pessimism will stop it once it starts.

There’s a trust composed of transparity at the local level.  A comfort level that can’t be found elsewhere.  Relationships are more familiar.  Business goings on clearer.  At at time when comfort is at a premium, local just feels better.

Implications for health care delivery are yet to be discovered (there is one nationally integrated system, but some are close, which very well could be positive).  Concerns could also arise, possibly regarding national expansion plans or organizational motivations.  We’ve yet to discover how big is too big in health care delivery (except for maybe this place).

An emphasis on local could certainly be a welcome development.  Shop local campaigns are blossomingGrowing food locally is rising in popularity, eating local too.  Health care has almost always been delivered locally; maybe it needs to stay that way.  Who better to understand the health care challenges of a community than local delivery organizations?

Thinking Globally, Acting Locally.

Most of the health care (the way we know it today) consumed in the United States is delivered locally (“Mary visits her doctor at the clinic with a cough”). Some of it is delivered regionally (“Laura is delivering her baby at the regional hospital”). A little bit is delivered nationally (“Mark is going to a specialist at Mayo”).

My thought is this: if so much of health care is based locally, why are we trying to solve its problems nationally?

Massachusetts (so far), California (it got somewhat close) and a host of other states have tried to reform health insurance at the state level–and have found reform to be expensive. If anything, this has shown us that policy reform needs to happen at the national level. That’s an important first step, but any health insurance reform aimed at covering all citizens does not address the issue of rising costs.

The needs of the people in each state are different. The needs of citizens at a local and regional level are different in those states. These needs can’t be solved with an overarching national reform effort to make us all healthier. They can be solved with local leadership, with local citizens, and with local programs.

Irving Wladawsky Berger writes at AlwaysOn in a post titled (Almost) All Innovation is Local, “But often, the best new ideas are found in those areas that you know best – right around you. Global aspirations need to be grounded in local actions.”

It’s easy to share. If we make every community in this country an innovation hub, collectively dedicated to solving the many problems of health care, the problems don’t seem so numerous. It’s comparable to the idea of cloud computing, where computing resources are used collectively to solve a particular problem quickly. If ideas work, communities can copy those ideas that other communities have tried. By developing a large menu of various ways to address issues, communities can select what will work best to address a specific problem.

Some organizations around the country are already dealing with health care issues locally by finding ways to provide access to all, promoting high-quality health care, finding ways to reduce waste and thus reduce cost, and making our communities healthier by promoting healthy behaviors. Some examples: Access Health Columbus, Healthy Memphis, Healthy Wichita.

Mr. Berger concludes, “Even the most global among us still spend most of our time and energy with our families, friends and colleagues right near our homes. We get most of our nurturing and inspiration from our local base. And, . . . it is this base that then enables us to go out and properly deal with the vast global world out there.”

While the platform for change will be built nationally, the solutions should be constructed locally.