Yes, We Should: 5 Ways to Transform Your Mindset to Improve the Health of Society
By Todd E. Davenport, PT, DPT, MPH
Valerie Rucker, PT, DPT, is right: "Yes, we can" be leaders in improving the health of our communities. As she pointed out in her recent #PTTransforms blog post, our Millennial colleagues are our profession's future. But I don't think we should just leave it to a new generation of physical therapists to transform how we think about health and health care. This Gen X-er is here to tell you that all physical therapists and physical therapist assistants have an important role to play.
The United States is home to some of the most advanced and abundant medical care. Our medical technology, research and development, and per-capita number of specialist physicians are among the best in the world. We spend 17.2% of our gross domestic product on medical care, which is the highest in the world by almost 5%, and amounts to over $3 trillion per year.
If US medical care is so advanced and we spend so much money on it, then our health outcomes must be at or near the top in the world, right? Not necessarily. Just look at the stats related to medical process and outcomes. We have higher rates of overall mortality, premature death, and preventable deaths than comparable countries, on average.
It's now clear we have a health problem in the United States.
It's also now clear that health care and medical care aren't the same thing, and that we aren't going to treat our way out of poor health using our old ways of thinking and doing.
I believe these 2 ideas should inform how we operationalize our new American Physical Therapy Association mission statement: "Building a community that advances the profession of physical therapy to improve the health of society." In turn, our efforts at community building will propel us toward realizing our professional vision: "Transforming society by optimizing movement to improve the human experience."
So, how do we start thinking about society so we can transform it?
And how do we start talking about communities so we can build them?
The answers to these questions are simple, but they're not necessarily easy to do.
Our mission and vision statements invite a fundamental change in how we see ourselves as PTs and PTAs, from expert and caring practitioners who provide care within the confines of a clinic to population health change agents.
Does that sound like a lot? It is! And that's what makes the challenge interesting and exciting.
Here are 5 places to start:
- Find your tribe. Find a group of people with whom to share, collaborate, learn, and act. There are PTs and PTAs who are actively involved in population health activities. Check out APTA's Council on Prevention, Health Promotion, and Wellness. The council already has assembled some great resources on the APTA (members-only) Hub, and they have organized some great conference programming to help you get started. Also, the Academy of Prevention and Health Promotion Therapies is an organization that cooperates with APTA and has some fantastic materials and collaborative tools to help clinicians of all backgrounds.
- Get to know what your community needs. You might know the needs of your own patients very well. However, your caseload might not reflect the broader community and might be skewed by case mix, insurance, referral sources, and geography. A good place to find more information about your community's needs would be your state or local public health department or nonprofit hospital system. These organizations often produce community health needs assessments that can help you get to know your community in a new way. Public data also can help you understand your community's health needs.
- Do a little asking around. Find agencies that align with critical community health needs, and ask how you can help. For example, local opioid safety coalitions have been organized in California to address the unique social, cultural, and political underpinnings of the opioid crisis. These organizations can coordinate with other stakeholders in providing services that can mitigate the incidence and prevalence of opioid use disorder in our communities, including addiction treatment programs, prescribers and pharmacists, school representatives, city and county officials, and public health officers. This model could be extended to other coalitions organized around active transportation, healthy aging in place, and other community health needs.
- Find new income sources. Funding for population health initiatives will require us to "add by subtracting." That is to say, every dollar of savings on lost productivity and medical care that we provide to an organization can become our dollar of income. This way of thinking will require us to get outside our predominant habit of fee-for-service medical billing. Direct-to-employer contracts and community benefit funding are just a couple of examples of income sources to cover your costs while improving the health of your community.
Direct-to-consumer wellness arrangements also might be designed to address community health needs. Be aware that these types of cash-based services will be directed to people who can afford your services out of pocket, which might lead you to unintentionally widen existing wealth-based health disparities in your community.
- Advocate for a healthier society. Sixty percent of the variance in premature deaths is attributable to an individual's behaviors and social factors. Social and environmental contexts often influence whether an individual practices healthy behaviors. These social determinants of health are group characteristics that, in turn, predict an individual's health and access to health care. They include race, gender and sexual identity, occupation, education, wealth, built environment, and geography. In other words, your health depends in large part on who you are, where you live, what you do, and who you're attracted to and partner with.
Physical therapists and physical therapist assistants should be active in advocating for a society in which people can be healthy where they live, work, play, learn, and worship. Part of advocating for a healthier society will necessitate that our profession addresses health and health care inequities that exist based on our communities' relative social vulnerability.
So, I add a hearty "Yes, we should" to Valeria Rucker's "Yes, we can." By building healthier communities, we can ensure that the physical therapy profession remains vibrant, engaging, and dynamic in responding to our public's changing health needs now and in the future.
Todd E. Davenport is professor and director of the physical therapy program at University of the Pacific.