Changing Course

Why physicians, politicians and communities must work together for better health

Josh Sharfstein, Secretary of Health and Mental Hygiene in Maryland delivers the annual Seidman Lecture. Image: Steve LipofskyIn an oddly quiet hospital in rural Maryland, the hospital CEO is delighted that the facility is running at only 60 percent of capacity.

“It’s like the anti-gravity zone for how the health care system usually is,” said Josh Sharfstein, Secretary of Health and Mental Hygiene in Maryland.

Sharfstein was describing a scene from one of his visits to a hospital that was participating in one of a series of experiments designed to make Maryland more healthy.

In this case, the hospital receives a set budget for the year, which it must use to care for the members of the community it serves. Under this system, the hospital is better off financially when it helps patients stay well, as opposed to the fee-for-service system that predominates in the U.S., where hospitals earn more money every time a patient comes to the hospital.

“At this hospital, they’ve had a culture change that isn’t quite, ‘We hope to never see you again,’ but it’s close: ‘We want you to be healthy and not come back,’ ” said Sharfstein, speaking at the 13th annual Seidman Lecture, hosted by the Harvard Medical School Department of Health Care Policy.

“Compare that to hospitals that are advertising on the highway: ‘Two minute wait in our ER, come on in,’ ” he said.

Sharfstein cited examples from other Maryland hospitals, including one that took on responsibility for the local community’s school nurse program. The hospital administrators realized that investing in school nurses would be a more effective and less expensive way of caring for children with chronic conditions such as asthma, which are often left untreated until they are so severe that costly hospitalizations are required.

The traditional health care system is aligned to promote growth, not health: more patients and more procedures mean that more money circulates in the system, Sharfstein said.

One of the key obstacles to effective health care reform across the U.S. is that this misalignment prevents innovative solutions from taking root. “Until you can turn that ship overall, it’s hard to get these good things to happen,” he said.

Complex, long term tasks like reforming the entire U.S. health care system aren’t the only challenges that require collaboration, Sharfstein said. Even simpler and more acute problems require multiple sectors to work together toward the goal of increasing health.

Sharfstein is a pediatrician and an alumnus of Harvard University who served as investigator and health policy adviser on the House Committee on Oversight and Government Reform, as Commissioner of Health for Baltimore City, as a health policy adviser to the 2008 Obama campaign and transition team and as principal deputy commissioner for the FDA.

Drawing on these experiences, he shared a series of case studies that highlighted the need for cooperation between physicians, politicians, public health officers, researchers, journalists and community members.

In one case, Sharfstein told the story of a friend, a dermatologist who saw a baby at a Philadelphia hospital with what looked like a severe diaper rash. It turned out to be a case of malnutrition caused by a diet of rice beverage, which, although it contains virtually no protein, was at the time advertised as a nutritionally complete dairy replacement drink. While that baby recovered, a literature search showed that other children had died from the same condition.

The dermatologist who first saw the baby didn’t stop when he referred the child for a dermatological consult. He wrote a paper for a medical journal, he contacted the press, he reached out to the manufacturers of the beverage, and he called his friend, who happened to be working for Congressman Henry Waxman at the time. Waxman contacted the companies and the FDA. The companies agreed to change the labeling on rice beverages to help keep other children healthy.

Sharfstein also noted that physicians and academic researchers who are interested in effecting change should think about working outside the bounds of academic publishing and medicine.

“As you think about problems and solutions, it’s important to think about where decisions could be made and try to be strategic about bringing that data to the right place,” Sharfstein said.

Click here to view a video of the event.