Periodically, this newsletter serves as a vehicle for discussing how terminology inexactitudes can have a detrimental impact on health care quality. A recent example appeared in the September 26, 2023 issue of the journal Neurology. Brain health is crucial to optimizing both the function and well-being of every individual at each stage of life and is key to both personal and social progress. As a concept, brain health is complex and requires a multidisciplinary collaborative approach involving many professional and public organizations to bring into effect meaningful change. The term brain health is defined, however, in many ways or not at all, but used with profligate ease.
Consequently, there is a need to anchor multiple definitions to a common, comprehensive, and comprehensible explanation since brain health usually means physical cerebral health to neurologists, mental health typically denotes healthy behavior to psychiatrists, and social health seldom is connected to cerebral or mental health. Moreover, it is unlikely that an organization developing a definition will relinquish it, thereby dooming reconciliation through negotiation.
On a much wider scale, a similar degree of conceptual opacity characterizes the word “health.” According to an article in the September 2023 issue of the periodical The Milbank Quarterly, because of this opaqueness, health tacitly is defined narrowly as the absence of disease. The result is a perpetuation of a biomedical paradigm in health care with a focus on diagnosing and treating disease. This tacit definition yields poor investment in the inherent health potential of individuals relative to drugs and technology, thus fostering a misalignment between the goals of health care and the goals of individuals, communities, public health, and society.
A biomedical model is reflected in health care billing that generally requires coding for a recognized disease, billing for procedures that address diseases, and in most quality measures that address either processes or diseases over short horizons, i.e., 12-month time frames. Under the cloud of conceptual opacity, health care defaults to a disease-oriented model to the detriment of patients, society, and the promotion of meaningful health equity.
Instead, promoting health in health care requires investment in human capabilities and potential by enabling individuals to manage their health and by supporting their autonomy, competence, and healthy relationships while buttressing equity in social determinants of health (SDOH) that are critical to promoting equity in human potential and well-being. This approach will require a paradigmatic and cultural shift with implications for health care leadership, organizational culture, human development, funding allocation, care models, training, measurement, accountability, and health equity. Doing so will necessitate organizational and delivery reforms, systems for bidirectional relationships with community-based human service organizations, intersectoral partnerships to promote community health, and advocacy for “health equity in all policies.”