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You have urged doctors to resume the old practice
of making house calls in order to see how
patients live and to cut back on emergency room
visits. Are there other new "old" ideas that you
would recommend?
Benjamin Franklin had it right, "An ounce of prevention is worth
a pound of cure." We could bring down health care costs dramatically
and improve the length and quality of life by having a society
that is more healthy and committed because it is fit.
Another "old idea" that dates back to Franklin and beyond
is having a health care provider who is part of the network
and social fabric of a community. At the Foundation, we
refer to them as the front-line workforce, the people who
are actually doing the hardest job—the most direct care
with the patients. They are members of the community who
help break down the barriers that often prevent people from
feeling like that they are getting care appropriate for their
culture, that is meaningful to them, and has the continuity
they want and need. Connecting health care providers to the
communities they serve bears revival.
A very old concept that is particularly relevant for our
work with childhood obesity, is creating a healthy environment
for people to get back in touch with the equations
about how the energy we put in has to be matched with the
energy we burn. The proportions are now one and a half
times what they should be, and the amount of energy that
we are able to burn just doing our regular day-to-day activity
has diminished to basal levels.
What advantages do you see in examining patient
populations rather than individual patients?
While there is nothing like connecting with a patient one-
on-one and doing everything within your power to help that
person, there is only so much you can do in that one visit or
through the doctor-patient relationship.
For example, think about some of the work that has been
done to reduce the prevalence of tobacco use. As a geriatrician,
I frequently treated patients with health problems
that resulted from a lifetime of tobacco use and exposure.
As a physician there was little I could do. However, at the
Foundation, we have an opportunity to think about making
root changes: having smoke-free work environments, taxing
cigarettes, or setting the price of tobacco so that it is a deterrent
to smoking. By combining all those things, we can help
millions of people lead longer and healthier lives. For me, it's
like going from singular to plural.
When we take all of those societal or system-wide opportunities
for changing the population's health and combine them
with what individuals can do with one single patient, we really
have the opportunity to transform society in major ways. .
Interview by Suzanne Wolkenfeld, a business and financial
writer based in New York.
Wharton launched the first MBA program in health care management
in 1970, and continues to innovate with its newest joint program: the
Roy and Diana Vagelos Program in Life Sciences and Management,
established for undergraduates in 2005.
Wharton offers joint programs in health care, biotechnology, and life
sciences in conjunction with Penn's schools of Nursing, Medicine,
Veterinary Medicine, Dental Medicine, Engineering, and Arts &
Sciences.
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