Public heath, not health care, will lower Texans’ medical costs


We all understand how an apple a day keeps the doctor away, but we struggle to embrace the wisdom of how safe housing, nutritious food and clean air reduces medical bills for everyone.

Marks’ campaign began after Episcopal church leaders sold the St. Luke’s hospital system in 2013 to Catholic Health Initiatives, then the nation’s second-largest faith-based health system. The church took the $1 billion in proceeds and hired Marks to run a new foundation.

After decades of providing health care, Marks and church leaders decided to put health before medicine.

“Health and health care, and financing for both, are the most complicated topics I’ve ever come across,” Marks told me. “I think we really have helped change the conversation in the state from, ‘health care equals health’ to ‘health is something, and health care is a piece of it.’”

The COVID-19 pandemic made all of us much more aware of the importance of public health. But preventing disease and injury in our community goes far beyond slowing viruses, providing vaccinations or changing behaviors.

Public health experts, like Marks, gather data on who is getting sick and injured, where the health care burden is highest, and ask what experts can do about it. Conducting research and advocating for change has become the foundation’s mission.

Marks has overseen more than $420 million worth of program investments through grants, research projects, community and congregational engagement, and impact investing to improve public health.

The research focuses on what public health experts call the social determinants of health. Studies show that economic stability, education, social interactions and neighborhood conditions are as crucial to a person’s health as their access to medical care.

“Five-plus years ago, you could not get people in the medical community to talk about social determinants,” Marks said. “I remember sitting in a meeting next to a doctor several years ago when somebody was presenting the basic social determinants, stuff that I can recite my sleep. He leaned over and said, ‘I’ve never heard this before. Do you think this is true?’ And for me, it was like, ‘Are you kidding? How could you not know this?’”

Most medical professionals and health care providers get paid a fee for providing a service. If a child comes into a clinic with asthma, the doctor and facility charge for the time spent on an examination, test results, diagnosis and a prescription.

The child will spend the rest of their life seeking treatment for asthma, a chronic condition with high costs.

Public health officials want to clean up the air in a neighborhood before the child develops asthma. They want to ensure no child lives in a home with black mold or other conditions that cause asthma. They have proven that the money spent on remediating mold in a poor person’s home is cheaper than lifetime bills that we all pay through higher insurance premiums or higher tax rates.

Marks said it’s hard to get health care professionals or the public to prioritize solutions that involve drywall installers instead of fancy machines.

“In our society, everything’s about high-tech robots doing surgery and the latest drug,” she said. “Even though the data showing that healthcare is only responsible for as much as 20 percent of health outcomes has been around for decades. People are fascinated with health care and don’t really appreciate the point that it’s just one small part of what it takes for a person or family or community to be healthy.”

People in the United States will soon spend $4 trillion a year on health care, even as data shows Americans are becoming less healthy. Better public health is the solution, not more treatment.

The most economical way to lower health care spending is to prevent people from developing diabetes, heart disease, respiratory issues or depression. The key is spending money on encouraging exercise, eating healthy, cleaning up the environment and providing more mental health care.

Only one of those solutions, however, delivers more money to health care providers. The others divert revenues from health care, which is unpopular in some circles.

Marks and the foundation have changed the conversation. The more difficult challenge ahead is changing how we spend our money. We have to decide we want a healthy society, not more medical procedures.

Chris Tomlinson writes commentary about business, economics and politics.

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