A community is like an organism, composed of multiple parts. When those parts are healthy and well, the whole organism is healthy and well. When some of those parts are not well, it impacts the health of the whole organism. This is why community health is important, and it is why I have been trying to explain my proposal for how we can and should work together to improve the health and well-being of everyone in our region. When you improve the health of one person, you aren’t just helping that person. You are helping the community to be healthier, stronger and better. It is also why people need to understand that the choices they make that impact their health, for good or ill, impact us all.
This is why everybody should care about community health. It is why everyone should pay more attention to their own health and wellness and why they should care about helping their neighbors be healthier, too. It’s not just a good thing to do because helping your fellow man is something that we should all aspire to do. It’s also the smart, pragmatic thing to do, because helping those other people to be healthier also benefits you. We all pay the costs of the poor health of our communities every day. Those costs show up in many different ways, direct and indirect, obvious and subtle. Let’s look at some of the costs of poor health. These are just a few of the ways poor health impacts us all. There are lots more less obvious ways.
- Higher taxes: We all pay for Medicare, Medicaid, Social Security Disability, charity care at hospitals and clinics and a host of other tax-supported mechanisms to provide healthcare for people who are government employees, elderly, poor, disabled and so on. It is appropriate that we do so. In 2016, according to the US Center for Medicare and Medicaid Services (CMS), we spent, as a nation, $3.3 trillion, which accounts for 19%, almost one-fifth, of the total economic activity of the US. That amounts to over $10,000 per person in the country. According to the American Journal of Public Health, 64% of that total is tax-funded, meaning that American taxpayers spent $2.1 trillion on government-funded healthcare in 2016. That number is projected to grow at about 5% a year for the next decade. A trillion, by the way, is a 1 followed by 12 zeroes. It’s a million millions. It’s a lot. How much of that $2.1 trillion was spent on care for conditions that were preventable? The US Center for Disease Control estimates that 86% of healthcare costs go to treat chronic conditions like diabetes, high blood pressure and heart failure. At least half of those conditions are preventable, which would save around a trillion dollars a year. That means that if we worked to achieve better health in our communities, we could save $1 trillion a year in taxes, just in decreased direct taxpayer-funded medical costs.
- Higher health insurance premiums: Insurance is fairly simple, in concept. A company charges people premiums to insure something—a house, a car, their health or whatever. How much they charge depends on how much they think they will have to pay out in benefits. By collecting money from a large pool of people, they can spread the risks and be able to predict what their payouts will be. This simple concept gets complicated by risk. It is known that certain people are higher-risks than others for various situations. That’s why it’s more expensive to buy car insurance for a 16 year-old, testrosterone-fueled, judgement-impaired boy than it is for a 55 year-old librarian. Young people are, by and large, cheaper to provide health insurance for than old people for the obvious reason that young people don’t have the same sorts of expensive chronic health conditions that are common among older people. This was the whole point behind the individual mandate in the Affordable Care Act. The only way that the government could convince insurance companies to offer insurance to everyone, including those with pre-existing conditions, was to ensure them that young people would also be required to join the risk pool. Anyway, the premiums individuals and businesses have to pay for health insurance are based on what the insurance companies have to pay out for health care. Healthier people are cheaper to insure, so the more healthy people there are in the insurance pool, the lower individual premiums can be. Improved community health will lower everyone’s health insurance costs.
- Lost tax revenue: This is sort of a combination of the first two issues. Businesses are allowed to deduct the amount they pay for their employees’ health insurance premiums from the taxes they pay to the government. The Tax Policy Center estimates that business tax deductions for healthcare costs reduce federal tax revenues by more than $250 billion dollars a year. If half of that amount is due to preventable conditions, we could improve federal tax receipts by at least $125 billion per year by improving community health.
- Lost productivity: This is a huge issue globally, and it’s even more so for rural areas because we have smaller populations to start with. Much of Europe, Japan and to a lesser extent, the US and Canada are feeling the effects of lost productivity due to declining birth rates. In parts of Europe and Japan, the birth rate is below the death rate, meaning the populations are declining. That means that the workforces are contracting. Technology and automation can make up for some of that, as many businesses are not as labor-intensive now as they were in the past, but the simple fact is that economic strength is dependent on the productivity of the work force. As the work force gets smaller or less productive, it saps the economic vitality of the area. People who can’t work due to preventable chronic illnesses can’t contribute to the economy. Even people who are still working but who are unhealthy are less productive than healthy workers. They also increase the healthcare costs for their employers.
There are many other ways in which community health impacts everyone, but I think the $3 trillion or so I just mentioned make the point. My health affects you. Your health affects me. That is just one of the reasons why we need to change our culture when it comes to our health. Working to improve the health of everyone isn’t just something we should do because we are decent people and it’s the right thing to do. It’s also something that benefits us all by improving the economy and freeing up tax money to be used on other things. That money could fix a lot of bridges and pay a lot of teachers.
What we can do in this small region of western Kentucky isn’t going to have much effect on the national economy, but it will have positive effects locally. Maybe more importantly, we can show other rural places that real change is possible and that we can make our lives better and build better futures and better communities for our kids to live in. What is absolutely certain is that, if we don’t do anything, nothing will get better. There is no magic wand and there are no quick fixes, but there are things we can do and we can start today. You know what happens if we start today, as opposed to tomorrow? We get there one day sooner, and you never know what that extra day might mean.