August 15, 2022

Healty

Slick Healthy

American Health Was Declining Before COVID-19. Now It’s

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In the wake of the COVID-19 pandemic, health experts have seen an alarming decline in overall health for Americans — and the U.S. healthcare system is partially to blame. Tom Werner/Getty Images
  • Medical experts say general health is declining in America.
  • This has partially been due to the COVID-19 pandemic, which has exacerbated a number of health concerns in addition to the dangers of the coronavirus.
  • In the wake of the pandemic, experts have seen a decline in patient interest in preventive care.
  • Inequities in access to healthcare have also widened in recent years, worsening health risks for many.
  • Experts say the American healthcare system needs to change in order to improve overall health throughout the country.

The health of the average American is on the decline.

In addition to COVID-19 causing more than a million deaths in the U.S., the pandemic has also negatively impacted American health in myriad ways, including increasing rates of obesity, fewer preventive healthcare appointments, and extreme economic insecurity that has further widened inequities in who can afford and access healthcare and health insurance.

Medical experts say all this and more has resulted in a less healthy America overall, and the current state of the U.S. healthcare industry is exacerbating the problem.

In fact, a recent survey from Actium Health painted a pretty broad picture of American health today.

By way of an online survey conducted back in February, the company collected responses from 1,230 adults in the United States, revealing a population that isn’t very proactive about seeking out healthcare and who describe a system they called “painful.”

Among the responses, while 92% of respondents said they feel preventive healthcare measures like routine screenings are “important to their overall health and wellness,” 35% say they are “reactive” about their health. This means they just make a doctor’s appointment when they feel a health issue is coming up, according to a press release for the study.

Those who said they don’t follow recommendations to seek preventive care cited reasons like “I don’t go to the doctor unless I have a problem,” “it’s too costly,” “making appointments is too much of a hassle,” and “I simply forget to make them.”

An especially damning indictment of the healthcare industry is that one out of five respondents said doing their taxes is “less painful” than managing their regular healthcare. Outside of the dreaded tax season, 52% cited house chores, 26% cited finances, and 20% cited child care as all being less painful than navigating healthcare.

When it comes to who is most responsible for making sure they engage with making and showing up to preventive health appointments, 30% said it is their doctor’s responsibility, while one out of 10 named their partner or spouse.

Ultimately, this stress around the healthcare system and shifts in behaviors since COVID-19 means many feel less assured of their own health. The survey revealed 50% of respondents said they felt “less healthy” today in 2022 than they did in 2019, during that pre-COVID-19 year.

When asked what was most surprising about the survey’s findings, Michael Linnert, founder and CEO of Actium Health, said there “unfortunately were not any major or big surprises.”

“The perspectives and validation from the healthcare consumers in this survey further indicate and hammers home the opportunity (and need) for health systems to not only be proactive in their communications but that the healthcare consumer expects each outreach to be highly relevant to them,” Linnert wrote in an email to Healthline. “It’s an opportunity for healthcare marketers to use the data they have to tailor their outreach efforts to each patient.”

Linnert explained that when healthcare consumers “are conditioned to receive highly tailored and relevant” communications from other aspects of their daily lives, “it’s alarming” that the new survey shows just 46% say that “outreach from their doctor is always relevant.”

“The challenge exists not when the patient is sitting in front of their doctor, but rather helping all the patients who are healthy and are not in front of the doctor or aren’t in the middle of an episode of care, which is the vast majority of patients,” Linnert wrote.

This sentiment that healthcare is not just a chore, but also something perceived to be unwelcoming — or even hostile — to the average American, is something that has long been on the mind of Felicia Hill-Briggs, PhD, Vice President of Prevention at Northwell Health and Co-Director of the Institute of Health System Science at the Feinstein Institutes for Medical Research.

Hill-Briggs told Healthline that what struck her initially about this survey’s data was the comment from respondents that managing the health system was painful. She said many of the patients she interacts with even go a step further, saying, “it’s traumatizing.”

Hill-Briggs, who was not affiliated with this survey, explained that the system has been traumatizing for people prior to the pandemic, during the height of the pandemic, and it continues today.

“Many of the things that were broken have remained broken, but people’s mindsets have changed,” she said.

Much in the way that people who were fortunate enough to work from home did not want to return to the monotony and inconvenience of “getting up and commuting to work for hours and sometimes sitting for hours in rush hour traffic” once things “reopened,” the same sentiment emerged around health appointments.

“Scheduling appointments is very difficult, where to call [to find an appointment], where to find a provider, who takes your insurance, then, maybe you have to wait weeks or months before you can even get an appointment and then by the time the appointment comes up you no longer need it, or your disease has progressed and gotten worse. The schedule of healthcare in America is not convenient for people,” she said.

These difficulties overlap with people’s jobs, child care responsibilities, school work, and social commitments, which Hill-Briggs said puts many in the position of “having to choose whether they get paid for the day and lose their jobs, or get a healthcare appointment and be seen.”

This reluctance to reengage with a healthcare system that many dislike has created a perfect storm where people aren’t going in for the preventive screenings they need and, ultimately, negative health outcomes will multiply.

Dr. Daniel Sullivan, who specializes in internal medicine and geriatrics at Cleveland Clinic, told Healthline that, from his vantage point, many patients have not returned to the pre-pandemic levels of engaging with their healthcare providers for preventive screenings like colonoscopies, mammographies, and laboratory testings, among other appointments.

“Not everyone has rescheduled and caught back up,” he said. “Early on in the pandemic, our ability to provide routine screenings was greatly diminished because we were extremely busy early on in the pandemic in meeting the emergent needs of COVID-19.”

That’s not the case now and Sullivan said it’s concerning that people haven’t been proactively seeking the care they need. However, he understands why.

At the height of the pandemic, he said many found it cumbersome that they had to go through additional steps before seeing their providers. You had to be screened for COVID-19 before a colonoscopy, for example. Now that some of those restrictions have loosened, he said things are “better than they were” but the healthcare system is still in “catch-up mode.”

“Getting people who were scheduled, rescheduled, is sometimes a challenge,” added Sullivan, who was not affiliated with the Actium Health research. “People’s work responsibilities have changed, their family responsibilities have changed, sometimes children early on were home, so sometimes leaving to get a mammogram was difficult.”

Sullivan cited other national surveys that echoed Actium Health’s findings. For instance, a report from the Harvard T.H. Chan School of Public Health found one in five people delayed needed preventive healthcare during the pandemic.

Similarly, a study from Texas A&M found one-third of adults decided to forego this important care early on in the COVID-19 pandemic.

He added that there is no definitive, single reason why so many people excused themselves from this care.

It’s partially due to the lack of availability from healthcare institutions as they tried to handle the crisis in real-time as well as the lack of access to care many experienced as they sheltered at home.

This was ultimately compounded by changes in social norms after the height of the pandemic that made many Americans reevaluate if they felt they really needed to see their provider in the first place.

“There is a tremendous opportunity for health systems to better engage and to activate their patients through proactive, relevant outreach. Healthcare consumers want to hear from their doctors,” Linnert wrote. “92% of the respondents in the survey believe preventive healthcare, such as screenings, is important to their overall health and wellness. But they need help. 30% of the respondents say it is the responsibility of their doctor for keeping them on top of their healthcare.”

As a result, Linnert added that “the time is now” for healthcare systems to “better engage their patients.” This means engaging people both in actual hospitals and clinics but also meeting people where they are “outside the four walls of the doctor’s office.”

“In addition to this survey, we see trends across the board indicating how healthcare consumers are driving their own wellness through the explosion and adoption of connected devices from fitness trackers to many other connected devices that help measure and report on health data,” Linnert wrote. “We see the acceleration of retail and digital health companies rising to meet the needs and expectations of healthcare consumers. We’ve also seen some health systems address patient access through digital front doors.”

For Cleveland Clinic’s part, Sullivan said the hospital system he works for has employed “navigators” who reach out to people and say “‘hey, this colonoscopy was due in 2021, it’s now 2022, can we get this scheduled for you?’ ” Then, after touching base with the patient, the navigator will put in the order “and close the loop,” he explained.

One gruesome takeaway Hill-Briggs said many people took away from the pandemic was that “I survived this at home on my own” and now there is a sense that they don’t have to take the trouble of navigating that “traumatizing system.”

While those with the worst cases flooded hospital intensive care units, many Americans sheltered in place, quarantined, and navigated the stress of managing the new virus all on their own.

This gave something of a false impression that regular provider visits were no longer needed, especially if it meant you could now avoid the confusing system of scheduling appointments and figuring out which doctor is the right fit for your needs.

Hill-Briggs said discussions about reforms to the system have long been in the ether. Over the past decade or so, a lot of the talking points revolved around “making healthcare patient-centered.” Of course, it didn’t really happen.

She said part of the problem is that our country isn’t set up to effectively be oriented around a prevention-focused model, despite the fact it is a nation riddled with chronic illness — something that will only get worse over time as we further quantify the ravages of COVID-19.

Hill-Briggs explained that the system was set up to be an “acute care system,” so that if someone breaks an arm or a leg, they get treatment, then go home.

Since “we are a country of chronic disease” the healthcare system has to somehow take that acute care model and make it fit the reality that is more about managing disease over years, even decades. This means monitoring and managing chronic diseases, dealing with their complications, of promoting preventive tools.

“As an industry, healthcare recognizes it has to transform how it delivers care in order to meet the current needs of a U.S. population,” she said.

Hill-Briggs cited the United States Preventive Services Task Force, a useful tool that not many Americans know about.

They list and update recommendations for needed preventive services that people should seek out and keep in mind at different age ranges. Just like how infants and children need to regularly be taken to providers for screenings, tests, and routine vaccinations as they grow older and hit specific age benchmarks, adults need to do the same, she added.

However, American society isn’t wired to accept that adults need to take these actions. Essentially, you leave childhood, grow up, and then the act of seeking preventive care becomes less a routine requirement, which can lead to a feeling that it’s more like an option than a need.

For those who do want to take the task force up on its recommendations, the system makes it extremely difficult to navigate this care.

“A patient can’t just show up to a doctor and say ‘I want to be screened for cancer.’ I mean they can say it, they can be saying it, wanting it, but that can’t get you screened,” Hill-Briggs stressed. “You have to meet all the rules and criteria in the recommendations and then your provider has to agree that you need that screening in order for you go somewhere to get those tests done. Despite the fact that these preventive services are national recommendations, they aren’t always covered by health insurance.”

“So, even if a patient is able to go and they are eligible and their provider agrees and sends them off for testing, the question becomes, ‘uh oh, can I do this out of pocket? Does my insurance cover these preventive services?’ ” she added. “These are those healthcare system-level problems that stand in the way of us turning over responsibility to patients to do the right thing and take a more active and engaged role in their health, and these are things we have to correct about our healthcare system.”

Linnert hopes the data from the survey “helps light a fire within health systems to start leveraging the rich data that they already have to proactively reach out to their patients … and help them manage their healthcare journeys.”

“The second step is to note that healthcare doesn’t stop, so neither should a system’s outreach. Breast cancer doesn’t only exist in October. Men’s health is not only a concern in June. Health systems need not only to be proactive in their communications, but they need to be continuous, or always-on, in their outreach,” he wrote. “Leveraging the rich patient data that is available to them, healthcare marketers can adopt technologies that help identify patients who are most at risk and prioritize those patients for outreach and preventive screenings and care.”

He added that many healthcare systems that do attempt better outreach ultimately “overwhelm their call centers or services lines,” which results in poorer experiences for staff and patients alike.

Essentially, Linnert and Hill-Briggs are in agreement: In order to make reforms, the healthcare system has to be open to change and be more efficient at administering it.

What can you do if you want to reengage with preventive healthcare, but have taken a break since the onset of the pandemic?

Hill-Briggs said the easiest thing is to contact your primary healthcare professional.

If you don’t have one, find one. Ask for referrals from friends or family, research providers who are covered by your insurance and who might be a good fit, for instance.

She said a primary care provider can help you navigate the complicated system. If you are having a problem but don’t know what specialist to seek first, go to your primary care provider and they can help you narrow it down from there.

Sullivan wanted to stress to the hospital-averse that we are not where we were in 2020. Hospitals are not overrun with COVID-19 cases and effective safety measures such as masks and vaccinated medical staff, mean you will be entering a facility that will possibly be one of the most coronavirus-safe places you could be.

He also stressed the importance of mental healthcare. Sullivan explained that his mental health colleagues cited how the psychological and emotional stress of the past two years have resulted in shifts in physical health, like unhealthy eating habits, for instance, which have had a trickle-down effect on weight gain and increased risk of conditions like diabetes.

Sullivan said that if you feel you are experiencing mental health concerns, don’t dismiss them as being less important than issues surrounding your physical health. Mental health care is preventive healthcare, too.

Hill-Briggs said for the system to improve, all elements of the American healthcare ecosystem — from medical institutions, clinics, physicians, healthcare workers, and insurance companies — have to work together to create a better, more inclusive, less stressful, and streamlined experience. With that, more people will want to seek the care they’ve been putting off.

In the meantime, it is important not to put your own preventive care on the back burner.

“We in the healthcare industry have to open up about what is not working and work on solutions,” she said. “Then, I don’t think we will have a problem engaging the public and patients in doing their part in staying healthier, it can’t be traumatic in doing so.”