With the President's address to Congress on health care reform yesterday, the grass roots are in a highly energized state. I have received at least 4 separate e-mails yesterday from 4 separate organizations calling on me to advocate for an emphasis on prevention. Call Congress, write the President, let your feelings be known!Well, my feelings are in fact these: We need a bracing dose of humility. The foundations of “health” are not built in hospitals or clinics. They are built in kitchens and family rooms; in schools and neighborhoods; and in supermarkets and backyards. Here's what I think:1) I believe basic access to needed care is a human right, so universal coverage -- by one means or another -- is a must. 2) I believe we can do far better at standardizing quality, and by so doing, saving both lives and dollars.3) I believe that how people live their lives each day—whether or not they smoke, what they eat, whether or not they are active, and so on—is the master lever of medical destiny. To look for the true power of disease prevention and health promotion in so-called “health care reform” is to look well beyond its horizon. Health care matters most when things go wrong, but can do relatively little at the points of true origin to ensure things go right.My worry is that in expecting too much of health care reform, we may simply fail to achieve any aspect of it. We need health care reform to ensure that what clinicians can do, they do well—and for everyone. But we must acknowledge that clinicians alone cannot build the foundations of health. For that, we need reforms that reverberate through our culture and society, to the places we actually live out the lives we are trying to protect.
