Dr. Dariush Mozaffarian
Appearances
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Well, I think it's all the above also having pathways. Again, as you said, there's no real pathway. Medicare, Medicaid don't really know what to do with a lot of these interventions that are not sort of the traditional sort of medical model. As you know, in 1965, when Medicare was first created, it was essentially paid for the treatment of disease using routine medical services.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
So it hasn't really caught up with today's day and age and what we know about the importance of lifestyle medicine either. with prevention or treatment. So I think some of this is research. Some of this are new pathways in the government, regulatory pathways. Some of this is educating the public.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
It's really going to take, I think, all of the above to sort of change the status quo, because there are a lot of opportunities out there that are not being realized.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Yeah, I just want to highlight and repeat what you said. You know, one in five dollars in the entire U.S. economy is spent on health care. One in four dollars in the entire federal budget is spent on Medicare and Medicaid.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
This is swallowing the economics of our country. It's swallowing our government budgets. It's swallowing competitiveness of business. It's pretty shocking if you think about, you know, food, how big of a part of our lives it is, how big of a part of the economy it is.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
I can't think of any other part of our economy, any other products that we interact with every day where safety is left up to the consumer. Imagine if you went to toy stores. I love this analogy. Just imagine you went to toy stores and everybody knew there was lots of toys that were unsafe for the kids. There were lots of toys that were okay, a little bit unsafe, but not fully safe.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
And there were some toys that were really safe. Or you walked into a building and, or you went to buy a house and some houses met earthquake standards and fire standards and electrical standards and plumbing standards. Others didn't at all, not even close. And some houses were kind of in between some things were met or other things were not met or teachers in school.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Some teachers, you know, were, were safe, you know, and were good for the teachers and others were known. Everyone knew the teachers were dangerous for the, for the children in different, different ways. Yeah. we would never leave it up to the individual family or the individual person to deal with that mess, right? We would say, this is outrageous, right?
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
We want safe toys, safe cars, safe homes, some minimum standards, right? And yet in food, it's the only system where we sort of say, well, it's up to the individual person. We need education. We need labeling. We need dietary guidelines. We just need to leave it up to the person and just not do anything else. And I think, again, that's
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
That's, to me, kind of the craziest thing about our policy approach so far is that it's all up to the individual consumer. And so, of course, we need to keep choice, and there's a range of foods that people should be able to choose from, but all of them should be reasonably safe.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Well, yeah, I get asked about my thoughts on the role of the food industry a lot. And it's like everything else. It's complicated. It's not straightforward. So first, I have to say that the food industry has followed and continues to follow a lot of the really harmful and
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
unwelcome playbook of tobacco, where it's about deception, denial, attacking the scientists, hardball lobbying, softball buying of influence, a lot of the same tactics. But I think at the end of the day, you know, the analogy to tobacco only goes so far. And many of those examples are actually around soda and big soda. There are still present for other foods, but it's really about Big Soda.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
But I think the analogy with tobacco only goes so far for a few reasons. First, the food company is incredibly diverse and heterogeneous. There's thousands of companies with thousands of products compared to tobacco. Second, I think that with tobacco, it's a fight to the death. Whereas with food, we need the food industry. We need their scale. We need their expertise. We need their technology.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
We need their distribution systems. And when I say big food, I mean from agribusiness to large supermarket, international supermarkets, to restaurants, to manufacturers. People think of the manufacturers, but there's four pieces to big food. Mm-hmm.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
And I think maybe most importantly, we shouldn't forget is the food industry mostly for the last 50 years did what we as public health experts and scientists told them to do. And now in the last 20 years, it hasn't been that long as we've really gotten to new science. We're saying, wait a minute, while you did what we asked you to do, slow down and change and refresh.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
And this is where the problem is that some food companies are slowly trying to do the right thing and trying to pick that up, mostly because they're being pushed by their losses and sales. Yeah. Some because they believe in doing the right thing. Others are fighting and digging in every step of the way. So there's a lot of heterogeneity.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
But I think what's interesting is that... It was interesting.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Yeah, yeah. All the people I speak to and I've heard from, they see that the food revolution is coming. There's absolutely, the food in 10 years is not going to look like the food it does now. And so I think what keeps me up at night is not that there's not going to be change, there's going to be change, but that the change isn't going to be informed by evidence.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
And so, you know, we need innovation in the food system. We need investment in the food system, but going from Doritos to Cool Ranch Doritos is not innovation. going from gummy bears to non-GMO gummy bears is not innovation, right? We need real innovation.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
There's a major food company who wanted to reduce the calories in their ice cream, so they added air, right? So that per cup, there'd be fewer calories, right? But adding air to food is not going to improve its health, right? No. So, so, so I think that, you know, that's the kind of thing that I worry about.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Yeah. So, so we need to, we need to, but, but the, but the public, I think the biggest thing the public is demanding from their food right now is trust and big food is not trusted and that's a wake up call and that's good that that's a wake up call. And so I think that we don't want to demonize the entire food industry. There's a lot of folks trying to do the right thing.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
A lot of graduates from our school at Tufts in the industry trying to help them do the right thing. But we also want to work
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
And this is where, Mark, government has a key role, right? Because if you leave it up to every individual food company to try to fight the system, they're going to go under. If they innovate and the other companies don't, they'll go under. So this is where government has really a role to play to even out the playing field and help these food companies do the right thing.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Well, so you said a lot there. There's a lot of points there. And just what's really interesting, and again, sort of wonderful from a point of view of wanting to study this, is that just like there's no single magic bullet to eating, and nutrition science shows us that you can't just pick one piece of the diet and fix it and everything's fine, the same is true for policy.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
There's going to be no magic bullet. There's a range of solutions that are needed. I think that taxes and subsidies are pretty crucial, and I'll talk about that in a minute. But I would go back to your comment about subsidies.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
There's been this sort of popular myth that's kind of urban legend that's spread through the media that somehow there's subsidies to commodities that's making the prices cheaper. And I just want to really say clearly that's totally false, that all U.S. policy for commodities keeps the prices high. The reason, you know, what farmer in the US wants their prices low, right?
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
They all want their prices high. And so sugar is a great example. People say, well, their subsidies, you know, and first, most of the subsidies have turned to crop insurance. Crop insurance gives farmers insurance so that they have a really bad season because of drought or something. They don't go under.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
And so most subsidies now are actually crop insurance for those commodities, not direct cash subsidies. That's still a form of a subsidy, but it's not direct. But corn is a great example. We actually keep the price of sugar high in this country because natural Brazilian sugar is much cheaper than corn syrup. Much, much cheaper. Sugar from Brazilian farms than U.S. corn farmers.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Well, they make it cheaper than natural sugar by putting tariffs on the Brazilian cane sugar to protect corn farmers. Right, right. So if we took away all the price supports, which actually keep the price high, corn farmers would go out of business, but the market would be flooded with cheap sugar from other countries. So that's just one example of this kind of conventional notion somehow.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
I don't know, Michael Pollan, someone wrote about this and it's just entered the...
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
The great majority of commodity crops in our country aren't eaten by humans. So the great majority of commodity crops in our country go to livestock. or go to energy.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
We all agree that prevention's important, but why has it not been that policymakers sort of elevated, why haven't they elevated this issue to the top? And I came up with a couple of reasons that I'd be happy to share. I think the first is, and you touched on this, a lot of policymakers are just reactive in general, and prevention requires a proactive approach.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
I would have to go and look at that history. I don't know that history. I know about Earl Butts and his kind of green revolution, but the farm bill and kind of the subsidy approach has been oversimplified. There's actually a lot of things in the newer farm bills to promote specialty crops that are called specialty crops like fruits and vegetables to start to promote them.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
A better approach would be to go to the retail level, right? A better approach would be to go directly to the consumer. And I think we should do that because right now the price we pay for foods doesn't reflect the true societal cost of the food and healthcare and lost productivity and suffering. All the externalities.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Absolutely. And so it's really not a punitive or approach or a favoritism approach. It's just bringing true market prices to food, right? Food should reflect the true market cost and benefit to people.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
If we taxed most foods, most packaged and processed foods with a flat tax, 10%, 20%, 30%, whatever we could do, and then we used all of that money, crucially, we used all of that money to heavily subsidize at the retail level.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
at the consumer purchase level or at the farm cost level, if you invest in farmer training, new equipment, other things, then you would use all that money to invest in and reduce the price of minimally processed healthy foods like fruits and vegetables and nuts and seeds and plant oils and fish and yogurt and things like that.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
You would turn the prices upside down or at least more normal, where you couldn't buy
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
yeah 36 ounce soda for 99 cents anymore and you wouldn't have to pay 50 cents or 70 cents for an apple you'd pay 25 cents 20 cents for an apple you'd pay a dollar for a serving of salmon right you'd pay a dollar 30 for soda instead yeah that would change all the incentives for farmers for retailers for restaurants for manufacturers and for the consumer and so you know what's happened over the last 40 years is the price of
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Well, fruits and vegetables in season are still quite affordable. The USDA did a nice analysis of that. So fruits and vegetables in season are quite affordable, but there's a lot of fruits and vegetables out of season now, and those, of course, are really expensive because they're getting shipped around the world. So that's another challenge. But
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
But I think that price is clearly one tool that the government needs to use to help address healthier food. And it sounds sort of pie in the sky, like this will never happen, but there's now at least a dozen countries around the world that have passed soda taxes.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Yeah. Unfortunately, none of that money is being used, to my knowledge, for subsidizing healthy foods. And so that makes the taxes only regressive in terms of finances for the poor. Although it's progressive for health for the poor, it's progressive for finances. We should use the revenue from those taxes to create incentives and systems for making healthy food less expensive.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
while helping farmers, right? We don't want to just make the food less expensive by putting farmers out of business. So I think that price is just an absolutely crucial tool. And we've learned from Tobacco, for example, how important price is.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Yeah, well, there's a lot of challenges in North Korea for sure that maybe food wouldn't be the first thing I'd address, but it would be up there. So I think that there's probably... six or seven categories of policies that I think are really crucial. One is fiscal economic incentives.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
And the reason they're reactive is whether you're in the executive branch or you're a member of Congress, there are oftentimes so many emergencies, either real or imagined, or crises, or political controversies, that oftentimes you spend a lot of time reacting. Putting out the fire. Absolutely. As opposed to thinking about proactive policies to improve health.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
So like we talked about, direct-to-consumer incentives or taxes, industry incentives, fiscal incentives, give them incentives for marketing and advertising and developing of healthy foods, and give them disincentives for the opposite.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Yeah, that's actually been proposed in Congress. It hasn't, you know, gained steam or gotten out of committee, but it's proposed to take away the tax breaks that companies now get for marketing junk food, right? Fiscal incentives through SNAP, the food stamps program. Fiscal incentives is one category.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
You know, two other categories are crucial is to change the environments in schools and work sites. They're Kids spend much of their day in schools. Adults spend much of their day at work sites.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
There's a lot of ways, wellness programming, environmental standards, procurement policies to make schools and work sites, places where you, and hospitals, you know, places where you can only really get healthy food, food that tastes good and is healthy and is good.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Well, the 2010 Healthy Hunger Free Kids Act was actually a pretty enormous advance. And so school lunch is much, much better than it was before that. There are still holes, but it's actually probably one of the best policies, food policies we have nationally is the school lunch policy.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Well, soda's not allowed in public schools anymore.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
No, no. Soda's not allowed in schools, including sports drinks. Competitive foods, there's smart snack standards, and they're pretty much out of public schools.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Juices? 100% juice is okay, but sugar-sweetened beverages are out of schools with healthy, hungry kids. Pretty landmark, actually. There are, again, some holes, but it's pretty landmark. But more can be done. I agree. So I think schools, work sites, fiscal incentives, those are three categories. Healthcare reform. There's a lot to do in healthcare. And that's a whole other podcast.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
But getting food in the electronic health record, the number one cause of health is in tracts. in the electronic health record. That tells you everything, right?
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
About our health care system.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Yeah, fruit and vegetable prescriptions, medical education, medically tailored meals, changing quality guidelines, changing reimbursement guidelines. There's a lot to do in health care reform. Research and innovation is crucial.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Well, so yeah, you're describing medically tailored meals. And what you say is really crucial. About 5% of the population costs about 50% of health care costs. All the patients with really complex chronic diseases, kidney disease, cancer, heart failure, AIDS, a range of really severe diseases.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
And several interventional studies now have shown that if you actually give those people food, give them three meals a day, which costs about $20 a day, it's much, much cheaper. You save money because they don't go to the hospital, they don't get admitted, they don't go to the emergency room. Because of that, things are changing so quickly, Mark.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
And then prevention oftentimes takes time as well. So you have to have that patience. And oftentimes the results are, at least from a public health perspective, are often invisible when things are working and health is being protected. And so I think the first reason is that the mindset of policymakers needs to shift from being reactive to proactive.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Because of that, California has just launched a $6 million pilot to do medically tailored meals in eight counties in California this year. And if it works and they see the same results, they're going to extend it to all of California. So change is coming. Change is a coming. Change is a coming. Yeah. And so, you know, healthcare is a fourth bucket.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Another, a fifth bucket, which I think is crucial for policy is research and innovation. There's a lot we know, but there's so much left to learn. There's so much left to learn about how foods affect our brains, our microbiomes, the differences between different processing methods that we've talked about. I mean, we could go on and on and on.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Yeah, the numbers are really telling. The federal government itself estimated that all of its nutrition research is about $1.5 billion a year. And that sounds like a lot, but again, all of the country's drug industry research, pharmaceutical research is about $60 billion a year. Advertising on candy in the U.S. is about $5 billion a year compared to $1.5 billion on nutrition research.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
So advertising on candy is $5 billion a year, and just purchasing of candy is $50 billion a year in the U.S. And so that $1.5 billion is just nothing compared to what the true issue is going on.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
I have not seen that, but that really would be sad if that were true. Amazing. Yeah. So we really need research and innovation. I think we need a new National Institute of Nutrition at the NIH. The NIH has a National Cancer Institute, a National Heart, Lung, and Blood Institute. All these institutes focus on diseases. We need a National Institute of Nutrition.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
It's the National Institute of Health. Food is the biggest challenge to health. Let's create a new National Institute of Nutrition. And again, that sounds impossible, but the National Cancer Institute was added recently. to NIH not that long ago because of just the concerted acts of a few people going to Congress and saying, hey, we need a war on cancer. We need a war on
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
on bad food and a victory for healthy food. We need a National Institute of Nutrition. We need public-private partnerships and guardrails so industry can fund nutrition research. I think industry has a role to fund nutrition research, but we really have to figure out how to do that transparently and carefully and independently.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
It's, it's, it's a challenge. You know, again, the food industry is a heart healthy cereal with seven teaspoons of sugar. You know, that makes you want to quit the American Heart Association. It's challenging. It's challenging. I mean, I mean, the food industry has expertise that we need and they also have negative influence that we don't need.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
And so how can we use the expertise and, and minimize the negative. So, And then I think the last area, you know, and have transparency around food in general. And I think the last policy area, we talked about economic incentives, schools, work sites, research and innovation, the healthcare system. The last area is sort of quality standards. There are some basic things.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
The same way we have quality standards for toys or for cars or for houses. We need some minimum quality standards. And the easiest places to start are additives. So we need quality standards. Basically, the government's saying you shouldn't have too much of these things in food. It's just a minimum standard. We already have done that for trans fat. That's a huge win for the U.S.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
The second reason is it could very well be that policymakers are just not as attuned to the evidence base, whether it's lifestyle medicine, whether it's prevention, whether it's a social determinants of health. Understanding the evidence now that has been generated about the effects of all of these other modalities, I think is critical.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
We need to do that for salt and for added sugar additives. And then we need marketing restrictions on marketing of unhealthy foods to young kids.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
And when you don't know the evidence, then you tend to think, well, that might be a slush fund. Those dollars in prevention might be a slush fund and why should we support it? There are others then, as you said, who may think of prevention as, you're right, part of the nanny state. Prevention is about individual responsibility and the government shouldn't be involved.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
So I think those are a couple of reasons, but then I think it goes beyond that. Prevention and public health, they require resources. And right now in this country, if you look at our national health expenditure accounts, only about 3% of our dollars go to public health. Only about 5% go to primary and secondary prevention.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
And so even though we're in a tight fiscal climate, we're always going to be in a tight fiscal climate. Finding opportunities through our discretionary budgets or mandatory budgets, CBO doesn't always help with their tenure. budget window in terms of scoring.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Absolutely. Absolutely. And I think that's a very important point. And I think, so there needs to be more focus on finding the will really, the political will to expand resources using our discretionary budgets, as well as our mandatory budgets and through Medicare and Medicaid, because that's really how we scale things. So I think that's also a critical point.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
I think Dr. Hyman, another reason why policymakers haven't gravitated towards prevention is we have a $3.6 trillion healthcare system. And frankly, you can't make as much money on prevention as you can on treatment. So the incentives there in the system are not as much there. Now, value-based healthcare- Not from the government, but from the people running healthcare. Absolutely.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Now, value-based healthcare transformation with the focus on payment based on outcomes as opposed to volume should change that over time. But that's- It's gonna be a long haul.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Absolutely, absolutely. We're about a decade into this, but still the vast majority of healthcare payments are still currently paid based on the services provided and a fee per service. So we're not quite there. And I think the last reason why this hasn't really gotten the attention of policymakers is really, I think if you look at the general public as well, we haven't galvanized
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
the American public, and whether that's they don't realize the power of prevention or we haven't communicated to them the importance of sound policies to support the healthy choice. Policymakers need to
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
help americans make the healthy choice the easy choice and so i think galvanizing the public you know they're not a lot of lobbying firms or interest groups going to members every single day in the halls of congress preaching preaching the power of prevention but but you do need a grassroots movement you do need the american public to say hey
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
I'm doing everything I can every day for my family to eat well, to exercise, to avoid substances, to stop smoking, to drink alcohol in moderation. I'm doing everything I can. But if there are not community supports, if there are not policy supports, if there aren't policy systems and environmental change helping me and my family, it's going to be very, very difficult to do.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
And I think that's a critical message in this book.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Prevention, public health, it's too important to underfund this. And there needs to be bipartisan support to finance evidence-based prevention and public health interventions. So it could be community-based prevention programs. I talk about several things that we did at Health and Human Services from the Recovery Act back in 2009.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
There are opportunities to finance the public health infrastructure, which is significantly underfunded in this country. The public health emergency fund, so the next Ebola or the Zika we face, we're not waiting on Congress to fight for months at a time before their resources, but targeted investments to lift up prevention and public health, that has to be a national priority.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
We have a $3.6 trillion healthcare system and frankly, you can't make as much money on prevention as you can on treatment.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
And I think in terms of bipartisanship, how do you crack that nut? There was an important commission on evidence-based policymaking that Senator Patty Murray and former Speaker Paul Ryan actually led a couple of years ago and talked about sort of an evidence, the importance of evidence-based policymaking in that same vein.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
there ought to be bipartisanship around what are those priorities in the prevention and public health space that we actually need to invest more in. Right.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
That's right. That's right. And that leads me to sort of the fifth point, which is we need, Dr. Hyman, more research. I mean, we have evidence-based right now, but we need more research into prevention. Now, the National Institutes on Health estimates that 19% of their budget every year goes to prevention. Now, one could ask, is that the right number or not? I don't know.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Now, there was another study that I recently saw that if you look at the National Cancer Institute, only 5% of their budget goes to prevention. So whatever the number is, I think that these are all sort of low.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Right, right, right. And so I would argue, and I argue in the book, that there ought to be a much more... focused research emphasis on prevention that looks at not just sort of the biology of illnesses, but also the importance of behavioral change, as well as policy, as well as other areas. And that will also actually help the Congressional Budget Office
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Irrespective of what happens with the 10-year budget window, the more research, the more evidence there will help policymakers. So I think in all five of these areas, number one, leadership prioritizing prevention. Number two, healthcare professionals focusing on prevention, not just management.
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
Number three, a parallel pathway for lifestyle interventions and evidence-based community prevention interventions. Number four, public health resources. And number five, prevention research. All of these
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
They're all heavy lifts, Dr. Hyman, but I think that I wouldn't be writing a book if these weren't heavy lifts, but these are absolutely important for policymakers on both sides of the aisle to understand the importance of these. And I think if there's movement on the policy side, the American public will
The Dr. Hyman Show
Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It
We'll see this also as a way to support themselves as they try to make sort of the healthy choice. But the American public is clamoring for assistance. Behavioral change is difficult given the environment, which you have so beautifully described. And I think the best way to counter that environment is through policy change and empowered Americans speaking out.