I’ll never forget my patient, Brenda. A 24-year-old with commercial health insurance, she came to me with concerns over weight loss, hair loss and fatigue. To figure out her diagnosis, I ordered expensive blood tests. They came back normal.
Puzzled, I asked more questions. I had no qualms asking about vomiting, diarrhea or her menstrual period, but it took three office visits before I worked up the courage to ask, “Is there something going on at home?” It turns out, she had no home. To pay her community college tuition, she was living out of her car and skipping dinner most nights.
Some variation of Brenda’s story plays out every day across North Carolina. The truth is, we have a health care system where asking “are you hungry?” is so far outside of what “counts” as health care, that we often fail to ask. The result is patients get and stay sicker, and we miss opportunities to spend health care dollars as effectively as possible.
In our state, we have some of the best medical care in the world. But even if folks get the right diagnoses, have insurance to fill their prescriptions and have transportation to pick it up from the pharmacy, it means nothing if they can’t refrigerate their medication because they can’t afford their electric bill.
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Good health is important but it’s also required to grow our state’s economy. To seek and maintain employment, to start and grow small businesses and to learn new skills, North Carolinians need to be healthy. In 2010, North Carolina spent almost $54 billion on medical bills and lost worker productivity due to known risk factors for chronic disease.
As the Secretary for the N.C. Department of Health and Human Services, my job is to ensure our public dollars are used to buy health – not only health care – for our citizens. We must look beyond what is typically thought of as “health care” and invest more strategically in health.
Currently, 90 percent of health care spending in the U.S. is on medical care in a hospital or doctor’s office. Access to medical services is crucial to being healthy. But research shows a person’s overall health is also driven by other factors, such as whether people have a stable, safe home, enough nutritious food to eat and transportation to get to their job or doctor. If we focus only on providing access to medical services but overlook other needs that affect a person’s health, we leave money on the table.
Here in North Carolina, we are fortunate that the private sector has begun developing innovative approaches for knitting together our health care system and communities. At DHHS, we want to make it easier for providers, insurers and community organizations to connect people with the resources they need to be healthy by accelerating and scaling these efforts to meet the needs of communities statewide. Spurred by our Medicaid transformation to managed care, we hope North Carolina will be a leader in addressing social determinants of health through initiatives like standardized screening, resource navigation and community partnerships.
Ultimately, we envision a North Carolina that optimizes health and well-being for all by effectively stewarding our collective resources to unite our communities and health care systems. After all, no matter what our respective goals – to mitigate the opioid crisis, to ensure our children are ready for school, to increase employment or to drive economic growth – it all begins with healthy people. No one of us alone will have all the answers, but the direction we must go is clear and together we can achieve this vision.
Dr. Mandy Cohen, an internal medicine physician, is Secretary of the N.C. Department of Health and Human Services.