Poor Primary Care Linked to Poor Population Health

Americans are not getting a lot of value for their health care dollar, which seems to be -- at least in part -- due to poor access to primary care physicians, according to Ichiro Kawachi, M.D., Ph.D., professor of social epidemiology and director of the Harvard Center for Society and Health.

Between public and private payers, said Kawachi, America spends more than twice as much per capita than the United Kingdom on health care. Yet, average life expectancy is lower in the United States than in Britain.

“Despite spending that amount of money, we purchase a low level of health,” Kawachi told an audience of health care stakeholders attending a Sept. 22 forum sponsored by the Robert Graham Center. It’s unlikely that lifestyle explains this difference, he added.

The United States and United Kingdom have very similar levels of smoking, and heavy drinking is actually much more common in England, according to Kawachi. The biggest difference between the two countries is the proportion of residents who are either obese or overweight, which seems to be due more to lack of exercise among Americans than a good diet among the British.

However, the United Kingdom ranks at the top and the United States at the bottom of countries listed in order of strength of their primary care system, said Kawachi. High scoring countries, based on regulation and financing of primary care, had lower all-cause mortality and, more specifically, fewer deaths from asthma, pneumonia and heart disease.

Primary care is integral to improving population health, said Kawachi. For one thing, any effort to eliminate health disparities hinges on access to primary care physicians. For another, family physicians are in a unique position to advocate for their patients outside the health care realm, either through helping them navigate social programs or by providing access to legal assistance.

However, family physicians may need to become advocates for themselves, as well.

“In the case of the United States, you have to take much more seriously national goals to shore up the primary care system,” said Kawachi.

For example, in Britain, physicians have the authority to write a prescription for physical activity that patients can take to a local gym. “That provides a direct link between primary care and prevention,” he said.