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Long before you meet with your doctor, factors like the neighborhood where you live and your financial situation impact where you shop for groceries, whether you can breathe clean air, and whether you feel safe and secure. And these situations can have real impacts on your health: Unhealthy eating can contribute to diabetes. Air pollution can cause or aggravate asthma. High levels of stress can contribute to a range of chronic health problems. It’s not terribly surprising that an estimated 80% of health outcomes are driven by factors that, at least on the surface, aren’t related to medical care.

A case in point: During my medical training, I went on ambulance ride-alongs with an emergency medical services crew. There was one call I will never forget: A woman I’d seen many times in the emergency department who suffered from congestive heart failure (CHF) and just wasn’t improving. People with CHF struggle with even simple tasks because fluid in their lungs makes it hard to breathe. She had the right medications and good medical care, so I wondered: Why wasn’t her CHF under control? I walked in her front door and had my answer: It was a hot Philadelphia day — well over 100 degrees — and she was sitting in front of a fan. I started to sweat just walking into her house. There was no way she could cook a meal or even go get her medications. She didn’t want to be unhealthy. She did not lack resolve. She lacked air conditioning. 

This is just one example of the factors outside of the traditional medical sphere that contribute to your overall health and well-being. That’s why the health system needs to focus on whole health — influenced by physical, behavioral, and social drivers — to improve outcomes.

What Is Whole Health?

The National Institutes of Health describes whole health as looking at the whole person to consider “multiple factors that promote either health or disease” and “empowering individuals, families, communities, and populations to improve their health in multiple interconnected” ways. This recognizes that each person’s circumstances contribute to making good health more or less likely, and that addressing underlying situations can improve health.

To illustrate this concept, take a different situation most people have probably experienced: running late. Say you blearily open your eyes, look at the clock, then wake with a start as you realize you overslept. You kick yourself the rest of the morning — after all, you didn’t want to be late. But instead of beating yourself up, a more effective strategy would be to address the factors that led to you being late — namely, oversleeping — by identifying why you slept late. Do you have young kids waking you during the night? Do you tend to stay up late scrolling through your phone? Do you have a racing mind that makes drifting off to sleep difficult? A combination of factors?

Addressing the underlying reasons that you overslept may not be easy, but examining your whole situation will ultimately make it more likely you’ll be on time in the future.

Similarly, simply telling someone to improve their health by eating nutritious food will probably be less effective than identifying why they aren’t eating food that’s better for them. Once you’ve determined the social drivers of health that are impacting their diet, you can work on strategies and resources that will empower them to eat better.

Adopting a Whole-Health Mindset

Social drivers of health impact people all across the country: Elevance Health’s “What’s Driving Our Health” study found that one in five people experienced a lack of transportation that prevented them from getting to medical appointments or work, or from obtaining what they needed. Forty-five percent reported feeling financially insecure, and CDC data indicates that 8.3 percent of adults didn’t take medications as prescribed to save money in 2020.

Unhealthy eating is frequently cited as a barrier to good health for good reason. Healthy diets reduce the risk for heart disease, type 2 diabetes, and certain cancers. Yet fewer than 1 in 10 people in the U.S. eat the recommended servings of fruits and vegetables, and 9 in 10 eat too much sodium. Why do so many people fall short of healthy diets? It depends. An estimated 54 million Americans experienced food insecurity in 2020 — up 18 percent from 2019.

Addressing affordability, financial insecurity, and accessibility could help some people in the U.S. eat healthier, which in turn could improve their health. Programs such as Feeding America’s Food is Medicine program are building a bridge between medical providers and food banks: Doctors screen for food insecurity and patients are connected with food assistance resources.

In this way, a whole-health approach to care identifies the barriers people face to achieving their optimal health and looks beyond what happens in doctors’ offices to improve the health of individuals and communities.

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