In this episode of Kentucky Health, host Dr. Wayne Tuckson speaks with Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, about the importance of preventive health care to improve quality of life for patients and cost effectiveness for providers.
An Ineffective Health Model Focusing on Rescue Instead of Prevention
The terms health and health care often are used interchangeably, especially by policymakers as they debate things like insurance coverage and medical expenses. But Ben Chandler argues health and health care are two very different things.
“As I say to people when I go out and give talks about it, I’ve never met a person who wants health care if they can have health,” he says. “Health is the critical thing. You can be the most wealthy person on the planet, and if you don’t have your health, it doesn’t matter.”
Most people readily accept this distinction when they stop to think about it, Chandler believes. However, he argues that our modern health care industry has emphasized providing health care instead of implementing patient programs that maintain good health and prevent diseases and chronic conditions from happening.
“In the final analysis, we’ve built a rescue system,” he says.
The problem exists at the individual level when a person continues to smoke or eat unhealthy foods despite overwhelming scientific evidence of their damaging effects. Chandler says the problem gets worse at the systemic level in the way policies are enacted. He contends that elected officials in charge of creating new public health legislation are often unwilling to pass mandates curbing behaviors that, while harmful to long-term health, are enjoyable to many.
“We as Americans, one of our biggest problems is that we really don’t want to be told what to do,” he says. “And that goes along to some extent with the freedoms that we hold dear, but there’s a price to be paid for that. There’s a price for those freedoms.”
A prime example of this, according to Chandler, can be seen in the response to the COVID-19 pandemic. He argues the nonconformist impulse of people in the United States coupled with a growing distrust of authority has led to more deaths from COVID because many people refused to take coronavirus vaccines. As of October, only 4 percent of Americans have received the fourth booster vaccine.
“We’re running into a situation where people are tired of it… and it’s pretty clear that if you go out in public, people are behaving as if the pandemic is over,” Chandler says.
That should not be the case when deaths from COVID still number in the hundreds per day. But Chandler is skeptical that messaging about the vaccines’ effectiveness will sway large numbers of people, many of whom have been exposed to and persuaded by misinformation on the Internet. And he points out that some politicians have used opinions about the vaccines as a wedge issue in public debates and elections.
“The vaccines have been very controversial, when they ought not to have been,” Chandler says. “The data on the vaccines is as clear as it can be. It’s just this simple – you are far better off getting the vaccine than you are having a bad case of COVID, period. So why would you not choose one over the other? Because just about everyone is going to get COVID, before this whole thing is over.”
The COVID dilemma exposes broader issues that help perpetuate the current inefficient health care system, Chandler believes. For example, he says corporations may fund medical studies that yield findings biased toward their own products. Chandler says the Foundation for a Healthy Kentucky only supports peer-reviewed research based on scientific data used to improve public health metrics.
“You’ve got to have the scientific data to back up what you’re saying,” Chandler maintains. “If you don’t have that data behind you, it’s just your opinion – you’re just talking, but you’re not talking with any authority.”
On a macro level, Chandler says the current health care system is, to an extent, at the mercy of food companies as well as the tobacco and alcohol industries.
“Another one of our problems is that a lot of our economy and a lot of the jobs that people have are based on making people sick,” Chandler explains. “(Food products) that are low in nutrition and very high in caloric content, I would submit are not good for you – and we produce a lot of that and a lot of people are employed doing that.”
Furthermore, many low-income areas are saturated with convenience marts, liquor stores, and tobacco outlets that distribute products harmful to health, which means that even if an individual living in one of these neighborhoods decides to make healthy consumption choices, their options are limited.
“The reasons people have bad health is often because of the circumstances they find themselves in,” he argues. “A lot of it is behavior – but a lot of it is behavior induced by circumstances that are often beyond people’s control. Poverty is one of the big (causes).”
A Commitment to Changing How Health Care is Practiced In Kentucky
The Foundation for a Healthy Kentucky was formed in the late 1990s as part of a settlement in a state lawsuit against Anthem Inc., which was required to set aside charitable assets into a public health foundation after they merged with Kentucky Blue Cross Blue Shield. Chandler, a former state attorney general and Congressman representing Kentucky’s sixth district, has been the president and CEO of the foundation since 2016.
“Changing public policy around health to get people to be healthier is not easy,” Chandler says, “and as you know, Kentucky’s health indicators are very poor.”
Chandler says that the U.S. spends twice as much on health care per capita as any country in the world. Yet, he says the health outcomes of Americans are no better, and in many cases worse, than for people in other countries.
“Why is that?” Chandler asks. “Because people have these very difficult, underlying, chronic problems... and we find ourselves having to spend a whole lot more money trying to rescue people who are already in difficult circumstances.”
One area of concern is diabetes: Kentucky is among the states with the highest rates of the disease, and persons with diabetes are vulnerable to a myriad of harmful and potentially deadly conditions. A leading risk factor for diabetes is obesity, and 2020 statistics indicate that 36.6 percent of all Kentuckians and 45.4 percent of Black Kentuckians are obese.
“Having too much weight is a significant problem, and you can do a lot (to prevent that) very simply – move around a lot, and eat better,” Chandler says. “It’s easier said than done, but that ultimately is the answer.”
To that end, the Foundation for a Healthy Kentucky works to educate the public about improving their diet and exercising regularly. They also advocate for communities to insert health and wellness goals into their planning, such as adding more sidewalks and/or recreational areas to neighborhoods.
Chandler concedes that it’s a challenge to promote healthy eating with an advertising budget that’s significantly smaller than those of food producers.
“If I’m in the game to win hearts and minds, trying to get people to want to consume things that are good for them, I’m not even being heard,” he says.
Chandler says that the Foundation does all it can to promote data-driven messages about improving health, although he is skeptical that society as a whole is ready to, as he says, “make a public decision to try to counteract” the corporate advertising. He acknowledges that the Food and Drug Administration regulates what Americans consume, but points out that their role is to make sure there are no immediate dangers in any product, not to determine long-term impacts.
“At the end of the day... everything we do is designed toward trying to move us toward a better and healthy situation in the state,” Chandler says. “We want the best health outcomes for our people.”
