Introduction
I have prepared this summary of the McKinsey Health Institute (MHI) article published in December 2022. MHI indicated in a previous article that, we can add years to life and life to years. Most of the drivers of good health sit outside the conventional health delivery systems. However, we devote more than 90% of our expenditures to treating sickness and symptoms. We need to define how we measure good health and address the drivers of health outside our conventional health systems.
Overview
The blueprint to achieve a lifetime of great health is increasingly clear and within our control. But unlocking it requires challenging the orthodoxies currently guiding individuals and institutions.
Each day, millions of well-intended health care professionals, scientists, and public health officials work diligently to improve our health. Their work has had a profoundly positive impact on global health over the past 50 years and deserves our admiration. However, the priorities, strategies, and budgets of governments, schools, health care providers, and employers are based on a myriad of half-truths and outdated ideas.
To borrow the metaphor from the 1999 eponymous movie classic, we have all been living in a “matrix” for decades with respect to our health. Life inside the healthcare matrix has its benefits but is incomplete and self-limiting. Once we escape from this matrix, we will realize the following:
- Mental, social, and spiritual health are as important as physical health and are deeply interconnected.
- Health exists on a spectrum: we cannot achieve optimal health if we do not define, measure, or strive for it.
- Most drivers of health sit outside conventional health systems and are modifiable.
- Achieving great health is as much about what we pursue as what we avoid.
- History suggests that the societal adaptations required to improve health are feasible; every person and institution on Earth has a role to play.
- Mental, social, and spiritual health are as important as physical health and are deeply interconnected.
Inside the matrix, people and systems focus almost entirely on physical health. In 2020, less than 2% of physicians and nurses worldwide were trained in managing mental health problems. More than 90% of all health care expenditures are spent on treating physical disease or physical symptoms.
University of Michigan researchers concluded that people without a strong life purpose were more than twice as likely to die, specifically from cardiovascular disease, than those who did have strong life purpose. In addition, research from National Academies of Sciences found that loneliness among heart failure patients was associated with around a four times increased risk of death and a 68% increased risk of hospitalization.
- Health exists on a spectrum: we cannot achieve optimal health if we do not define, measure, or strive for it.
Inside the matrix, health is framed almost exclusively in the negative. Achieving a “clean bill of health” means that you have not been diagnosed with a disease or a major risk factor of disease. Globally, we spend more than $8 trillion annually to avoid disease, symptoms, and death, yet there are no commonly accepted words or standards to delineate mediocre from great health.
A disease-free person who successfully improves their metabolic health, learns to navigate their emotions, prioritizes sufficient high-quality sleep, and avoids harmful content, substances, and stress is likely to enjoy more energy, build stronger relationships, and enhance personal productivity. They are more likely to be a better colleague at work, a better spouse, a better parent, and a better friend.
- Most drivers of health sit outside conventional health systems and are modifiable.
More than 97% of health-related public-, private-, and social-sector expenditures in OECD countries are related to delivering conventional health care interventions. When we acknowledge the relevance of a handful of non-conventional drivers such as diet, exercise, and substance use, we frequently refer to these drivers with dismissive terms such as “lifestyle.” The word “style” implies superficiality or inferiority compared to what we consider more legitimate interventions that we label with credibility-enhancing qualifiers like “clinical.”
The first step to achieving optimal health is to define it.
- Physical – High stamina/energy; excellent physical mobility, strength, balance; full sensory function
- Mental – High resiliency; setbacks lead to growth; full cognitive capacity – think, learn, remember, create
- Social – Infectious positivity, robust support network, high empathy, deep community affiliation
- Spiritual – Deep sense of purpose, belonging, and identity
The 23 drivers of health include: 1) Physical inputs – Diet, supplementation, substance use, 2) Movement – Mobility, exercise, sleep, 3) Daily living – Productive activity, social interaction, content consumption, hygiene, 4) Exposure – Nature, atmosphere, sensory, materials, stress, 5) State of being – Mindsets/beliefs, body composition, physical security, economic security, and 6) Healthcare – Vaccination, detection/diagnosis, clinical intervention, adherence
These twenty-three drivers of health are often the difference between decades of strong function and decades of poor health and/or premature death. Examples include the following:
- Exercise alone can deliver between three and five years of extended life and between five and 10 years of improved quality of life.
- Positivity reduces the prevalence and symptoms of depression and anxiety and improves immune-system function.
- Walking reduces chronic pain, strengthens the immune system, and decreases anxiety, sadness, and fatigue.
- Exposure to nature for 60 minutes can reduce stress and improve the brain’s ability to successfully navigate future stressors.
- More than five hours of daily social media use can increase the risk of depressive symptoms in adolescents by 35-50%.
Outside the matrix, we realize that the distinctions between “clinical” and “lifestyle” interventions are mostly artificial. Why is a pill or surgery a more legitimate health intervention than calorie restriction, lifting weights, meditating, or walking in nature? If it works, it works. If it doesn’t, it doesn’t.
Outside the matrix, we view these gaps in knowledge as creating an imperative to invest dramatically more resources in researching and understanding these drivers, rather than as a rationale to discount them.
- Achieving great health is as much about what we pursue as what we avoid.
People often comment that, “You’ll live to be 100 if you give up all the things that make you want to.” In fact, optimizing the drivers of health is mostly about doing more of what we enjoy intrinsically so we can continue to do those things longer. Most people enjoy some form of sport or physical activity if it is not labeled “exercise.” Outside the matrix, where day-to-day living is the primary determinant of health, we realize that we must be the stewards of our own health.
- History suggests that the societal adaptations required to improve health are feasible; every person and institution on Earth has a role to play.
Most of the favorable changes in human behavior typically involve a virtuous cycle of institutional and individual action. Every business realizes it is in the business of health. They realize that most (if not all) of the products and services they offer could affect one of the modifiable drivers of health. They recognize that helping people optimize their health could be an attractive economic opportunity and positively affect society.
Every employer recognizes the profound impact that an employee’s experience has on their health. The extent to which an employee finds meaning in their work, their interpersonal interactions, and the way in which they are developed (or not), materially affects every modifiable driver of health. Employers realize that improving the health of their employees is both just and economically attractive. They recognize that empowering individuals must be the foundation of our health systems.
Summary
Achieving excellent health is about much more than just getting good health care. We need to address the drivers of health outside our health care systems. There are great opportunities to improve whole-person health – physical, mental, social, and spiritual. Organizations outside of healthcare will lead the transformation in improving the health of Americans.