Transforming health care to improve U.S. life expectancy

The United States, renowned for its steadfast commitment to innovation and progress, confronts a disconcerting paradox: a decline in life expectancy amidst a backdrop of pioneering medical achievements. This contradiction, exacerbated in recent years, calls for a transformative reevaluation of the nation's health care paradigm. The remedy to this multifaceted challenge lies in the strategic embrace of primary health care, a comprehensive, patient-centered approach that not only promises to elevate health outcomes but will also revitalize the social fabric of our nation.

From the dawn of the 20th century to the present, the United States has witnessed remarkable progress, transitioning from an average life expectancy of 47 years in 1900 to a commendable 78.84 years in 2014. Advances in public health measures, lifesaving vaccines, groundbreaking medicines, and innovative surgical interventions have played pivotal roles in this journey. Yet, despite these achievements, a concerning decline in life expectancy has emerged since 2014, plunging to an alarming low of 76.4 years in 2021—a figure that remains stagnant, casting a shadow of concern.

The implications of dwindling life expectancy extend beyond mere statistical metrics; they reverberate throughout the core of a society. The very essence of a nation's health and well-being rests upon its people's longevity. Perhaps no single event has underscored the urgency of this issue more than the COVID-19 pandemic. As the world grappled with unprecedented challenges, the United States experienced one of the highest death rates among technologically advanced countries, 341.11 per 100,000 population. In addition, the recovery of other nations' life expectancies following the pandemic has been more robust than ours, a testament to the efficacy of their health care systems in safeguarding lives.

Myriad complex factors contribute to the sobering decline in U.S. life expectancy. The opioid epidemic, our burgeoning obesity crisis, alcohol abuse, firearm violence, suicides, mental health crises, social isolation, chronic health conditions, inadequate health education and literacy, health care disparities, limited access to care, environmental concerns, and multifaceted social and political drivers of health compound to erode the foundations of the nation's health and well-being.

This reaffirms the exigency of health care reform anchored in a proactive and comprehensive approach, uniting policymakers, health care professionals, communities, and citizens in a shared vision for a healthier future. The time has come to prioritize the bedrock of public health infrastructure, herald preventive measures, expand health care access (particularly for mental health services), address social drivers of health, grapple with environmental issues, and weave tighter social connections.

The pivotal role of a comprehensive primary health care system is clear from worldwide experience, including from resource-limited nations. A cornerstone of this recalibration entails the establishment of a robust primary health care system, one built on efficiency, accessibility, and integration. Imagine a system that places prevention at its forefront, a system that empowers individuals with knowledge and equips them with tools to avert diseases before they take hold. By emphasizing vaccinations, screenings, and health education, primary health care has the power to curtail the spread of illnesses, alleviating the burden on both individuals and the health care system. The scope of an effective primary health care system transcends the boundaries of traditional medical care. It encompasses medical, dental, and mental health as well as community and home-based services and takes a comprehensive approach aimed at nurturing holistic well-being. This model serves as a critical instrument in fostering equitable access to care and is a fundamental premise essential for meaningful progress. It is this ethos of equity that forms the linchpin for addressing health disparities, enhancing social cohesion, and fortifying the societal fabric, with dividends far beyond health indicators.

At its core, primary health care is a resolute proponent of health promotion, disease prevention, and comprehensive care coordination. The emphasis on these tenets fosters an ecosystem that catalyzes optimal health outcomes while simultaneously mitigating disparities, curbing disease burdens, and averting premature mortality. It is a system that mitigates the need for costly specialized treatments and hospitalizations, ushering in significant temporal and economic savings for individuals, families, and the entire nation.

The journey to a comprehensive primary health care system is not devoid of challenges. Workforce shortages, limited accessibility in rural and underserved regions, disparate distribution of health care facilities, and financial incentives that perpetuate a reactive, fragmented paradigm all stand as formidable barriers. The fee-for-service model, while deeply entrenched, perpetuates a cost-prohibitive approach centered on episodic care, rather than an economically viable, meticulously planned system rooted in the principles of effective primary health care.

As I mentioned in a previous column, the United States in 2021 spent a staggering $4.3 trillion on health care, an equivalent of $12,914 per person, comprising 18.3% of the GDP. A glaring contrast emerges when juxtaposed with countries such as Norway, which boasts a life expectancy of 83 years while spending a fraction of what we do. Norway's unwavering focus on primary health care as a pillar of universal health coverage sets a powerful precedent for the United States to emulate. While the merits of primary health care are evident, its economic impact cannot be overstated. By prioritizing prevention and early intervention, this approach diminishes the need for expensive hospitalizations and specialized treatments, with significant reduction in costs, a weight lifted off individuals and families, and a more sustainable system.

The pivot towards an all-encompassing primary health care system, intricately woven into the fabric of America, is a beacon of hope amidst these challenges. As a society forged on the ideals of a “more perfect union” and endowed with unalienable rights to life, liberty, and the pursuit of happiness, the time has come for a paradigm shift. From a reactive, fragmented “sick care chaos,” we must transition towards a proactive, harmonious health care model grounded in the principles of comprehensive primary health care.

The decline in U.S. life expectancy demands transformative reform. A comprehensive primary health care system, rooted in evidence and global best practices, offers a promising solution. The successful interplay of a well-funded public health system and a seamlessly integrated primary health care network forms the bedrock of an efficient, progressive, and sustainable trajectory. This trajectory extends beyond individual patients, cascading into favorable population health. By embracing this approach, the U.S. can forge a path toward a resilient, inclusive, and progressive health care system that aligns with its core ideals.