TED Salon Optum
Rebecca Onie: What Americans agree on when it comes to health
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We may not be as deeply divided as we think -- at least when it comes to health, says Rebecca Onie. In a talk that cuts through the noise, Onie shares research that shows how, even across economic, political and racial divides, Americans agree on what they need to live good lives -- and asks both health care providers and patients to focus on what makes us healthy, not what makes us angry.
Rebecca Onie - Health services innovator
Rebecca Onie is the founder of Health Leads, a program that connects patients to basic care and resources, such as food and housing, that are the root cause of many health problems. Full bio
Rebecca Onie is the founder of Health Leads, a program that connects patients to basic care and resources, such as food and housing, that are the root cause of many health problems. Full bio
Double-click the English transcript below to play the video.
00:12
Today, we are a country divided,
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or at least that's what we're told.
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We are torn apart
by immigration, education, guns
by immigration, education, guns
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and health care.
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Health care is ugly and it is loud,
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so loud that it threatens
to drown out everything else.
to drown out everything else.
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(Voice-over) Protesters: Health care
is a human right! Fight, fight, fight!
is a human right! Fight, fight, fight!
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Protesters: Hey hey! Ho ho!
Obamacare has got to go!
Obamacare has got to go!
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Rebecca Onie: But what if
underneath all the noise,
underneath all the noise,
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we're not divided?
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What if the things that we don't ask about
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are the things that we most agree upon?
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It turns out that when we ask
the right questions,
the right questions,
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the answers are startling,
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because we agree, not on health care,
but on something more important:
but on something more important:
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we agree on health.
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For 20 years, I've been obsessed
with one question:
with one question:
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What do we, what do all of us need
in order to be healthy?
in order to be healthy?
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As a college student in 1995,
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I spent months talking to physicians
at a chaotic hospital in Boston,
at a chaotic hospital in Boston,
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asking them, "What's the one thing
your patients most need to be healthy?"
your patients most need to be healthy?"
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They shared the same story
again and again,
again and again,
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one that I've heard hundreds
of variations of since.
of variations of since.
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They say, "Every day I see a patient
with an asthma exacerbation,
with an asthma exacerbation,
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and I prescribe a controller medication.
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But I know she is living
in a mold-infested apartment.
in a mold-infested apartment.
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Or I see a kid with an ear infection,
and I prescribe antibiotics,
and I prescribe antibiotics,
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but I know there is no food at home.
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And I don't ask about those issues,
because there's nothing I can do."
because there's nothing I can do."
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Now, it seemed that it shouldn't
be so complicated
be so complicated
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to design a doctor's visit around
what people actually need to be healthy.
what people actually need to be healthy.
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So I created Health Leads,
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an organization enabling thousands
of physicians and other caregivers
of physicians and other caregivers
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to ask their patients,
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"What do you need to be healthy?"
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and then prescribe those things --
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fruits and vegetables, heat in the winter,
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electricity to refrigerate
their medication --
their medication --
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and we then navigated
patients to those resources
patients to those resources
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in their communities.
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The model works.
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A Mass General Hospital study found that
navigating patients to essential resources
navigating patients to essential resources
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is associated with improvements
in blood pressure and cholesterol levels
in blood pressure and cholesterol levels
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similar to introducing a new drug,
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but without all the side effects.
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So two decades later, what's changed?
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It's now widely recognized
that just 20 percent of health outcomes
that just 20 percent of health outcomes
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are tied to medical care,
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whereas up to 70 percent
are tied to healthy behaviors
are tied to healthy behaviors
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and what's called the social
determinants of health --
determinants of health --
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basically, everything that happens to us
for that vast majority of time
for that vast majority of time
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when we're not in the doctor's office
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or the hospital.
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Health care executives
now routinely remind us
now routinely remind us
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that our zip code matters more
than our genetic code.
than our genetic code.
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And one health care publication
even recently had the audacity
even recently had the audacity
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to describe the social
determinants of health
determinants of health
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as "the feel-good buzzword of the year."
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Now, there's been some action, too.
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Over the past decade, six major
health care providers and insurers
health care providers and insurers
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have committed over 600 million dollars
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to affordable housing,
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recognizing that it reduces
infant mortality
infant mortality
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and increases life expectancy.
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But let's be honest.
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Is our 3.5 trillion dollar
health care system
health care system
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fundamentally designed to create health?
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Absolutely not.
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Take access to healthy food.
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Not long ago, a teenage boy shows up
at a hospital in Baltimore,
at a hospital in Baltimore,
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losing weight.
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Just as his doctors are huddled up
figuring out which metabolic panels
figuring out which metabolic panels
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and blood tests to run,
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one of my colleagues asks out loud,
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"Do you think he might be hungry?"
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It turned out that this kid
had been kicked out of his housing
had been kicked out of his housing
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and literally hadn't had a meal in weeks.
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He said he was "... so relieved
that somebody finally asked me."
that somebody finally asked me."
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Somehow, we've created
a health care system
a health care system
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where asking a patient "Are you hungry?"
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is so far outside the bounds
of what counts as health care
of what counts as health care
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that we mostly fail or forget
to ask altogether;
to ask altogether;
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where doctors lament a hospital's
"no third sandwich policy,"
"no third sandwich policy,"
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meaning that if you're
a hungry patient in the ER,
a hungry patient in the ER,
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you can have only two free sandwiches,
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but as many MRIs as the doctor orders;
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where, in 2016 in the state of Texas,
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they spent 1.2 billion dollars
on the medical costs of malnutrition
on the medical costs of malnutrition
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instead of on access to healthy food;
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where a Centers for Medicare
and Medicaid Services program
and Medicaid Services program
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stratifies hungry patients,
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so that some get access to food
and some get information about food,
and some get information about food,
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with the justification that
doing nothing for hungry patients
doing nothing for hungry patients
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is standard and usual care
in this country.
in this country.
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And that's just food.
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The same is true
for housing, electricity ...
for housing, electricity ...
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The bottom line is,
health care may be changing,
health care may be changing,
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but not by enough
and certainly not fast enough.
and certainly not fast enough.
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We ask the wrong questions
of our doctors, of our patients,
of our doctors, of our patients,
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but also of our citizens.
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We ask about and argue about health care,
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but how do voters think about health?
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No one could tell us
the answer to that question,
the answer to that question,
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so we launched a new initiative
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and hired a polling firm
to ask voters across the country:
to ask voters across the country:
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What do you need to be healthy?
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What was so striking about this
was that no one has any clue
was that no one has any clue
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what we are talking about in health care.
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Voters do not think
the social determinants of health
the social determinants of health
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is a feel-good phrase.
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They actually hate it.
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"What uneducated person
came up with that language?"
came up with that language?"
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one of the voters said.
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Or my favorite was the guy who said,
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"You're killing me."
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But when you strip away
all the ridiculousness
all the ridiculousness
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of our language in health care,
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we know exactly what creates health.
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So take Charlotte, North Carolina.
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We had two focus groups,
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one of African American Democratic women
and one of white Republican women.
and one of white Republican women.
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And we asked them,
"If you had a hundred dollars,
"If you had a hundred dollars,
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how would you spend it
to buy health in your community?
to buy health in your community?
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Turns out, they agree
nearly to the last percentage point.
nearly to the last percentage point.
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First, they agree that health care
only sort of impacts health.
only sort of impacts health.
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So they choose to spend
the majority of their dollars
the majority of their dollars
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outside of hospitals and clinics.
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And second, they agree
on what creates health,
on what creates health,
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spending 19 percent on affordable housing
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and about 25 percent
on access to healthy food.
on access to healthy food.
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So I am sure you are thinking,
"This has got to be a fluke."
"This has got to be a fluke."
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But it's not.
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White and Latino male
swing voters in Seattle,
swing voters in Seattle,
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white and African American
Democratic voters in Cleveland,
Democratic voters in Cleveland,
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white male Republicans in Dallas,
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low-income white Democrats
in Hendersonville, North Carolina:
in Hendersonville, North Carolina:
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their answers are strikingly similar,
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with all of them choosing
to spend more money
to spend more money
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on healthy food and safe housing
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than they would on hospitals
and health centers.
and health centers.
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When you ask the right questions,
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it becomes pretty clear:
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we may be fractured
on health care in this country,
on health care in this country,
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but we are unified on health.
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The thing that I've been
struggling with is why.
struggling with is why.
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Why do we agree on health?
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We agree on health
because it is common sense.
because it is common sense.
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We all know that the things
we need to get healthy --
we need to get healthy --
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medicine and medical care --
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are not the things we need to be healthy,
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to not get sick in the first place.
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But we also agree because
of common experience.
of common experience.
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In a study of 5,000 patients,
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24 percent of the patients
with commercial health insurance --
with commercial health insurance --
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meaning, they had a job --
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still ran out of food or struggled
to find housing or transportation
to find housing or transportation
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or other essential resources.
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Twenty-four percent.
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And we saw the same thing
in our focus groups.
in our focus groups.
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Nearly every voter knew
what it meant to struggle,
what it meant to struggle,
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either themselves or their families
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or their neighbors.
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One of those white Republican
women in Charlotte was a waitress
women in Charlotte was a waitress
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struggling to stay awake
with an enormous Big Gulp soda.
with an enormous Big Gulp soda.
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She just looked exhausted.
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And she was.
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She told us that she worked two jobs
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but still could not afford
a membership to the Y,
a membership to the Y,
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but it was OK that she couldn't go
to the gym, she said,
to the gym, she said,
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because she also could not afford gas
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and walked 10 miles to and from work
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every single day.
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Listening to her, I felt
this familiar panic rise in me,
this familiar panic rise in me,
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the residue of my own childhood.
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When I was 10 years old,
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my father lay on the living room floor
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in the grips of one
of his many depressions.
of his many depressions.
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As I crouched next to him, he told me
that he wanted to kill himself.
that he wanted to kill himself.
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My father lived,
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but he struggled to work.
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And my family survived,
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but we teetered,
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down one paycheck,
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relying on my mom's schoolteacher salary.
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Even as a little kid, I knew
we lived in the shadow
we lived in the shadow
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of financial and emotional collapse.
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This is really hard to say,
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because it's taken me 25 years
to be honest with myself
to be honest with myself
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that this is why I do this work:
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knowing that my father
needed health care to recover,
needed health care to recover,
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but to be healthy, my family
needed something else,
needed something else,
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we needed a decent income;
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and knowing, as so many do more than I,
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that panic when the basics
threaten to slip away.
threaten to slip away.
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To the voters in our focus groups,
the solutions were straightforward.
the solutions were straightforward.
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As one of those white Republican
women in Charlotte said,
women in Charlotte said,
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"Instead of putting all this money
into health care,
into health care,
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put it into affordable housing.
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You know, like, take it
and distribute it differently."
and distribute it differently."
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It turns out that when you have
the right language
the right language
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and you ask the right questions,
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the answers become remarkably clear
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and unanimous.
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What we know is that,
despite all the noise,
despite all the noise,
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the plan for health care in this country
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is that there is no plan.
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But we have something more powerful
than any politician's bill,
than any politician's bill,
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any candidate's platform,
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any think tank's policy statement.
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We have our common sense
and our common experience.
and our common experience.
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So I ask, if you are
a health care executive:
a health care executive:
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Do you know how many
of your patients run out of food
of your patients run out of food
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or struggle to pay the rent
at the end of the month?
at the end of the month?
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Is that data on your scorecard,
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shaping your business and your bonuses?
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If you are a politician:
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Will you continue to fight
on the scorched earth of health care,
on the scorched earth of health care,
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or will you act on what your voters,
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what Democratic
and Republican voters alike,
and Republican voters alike,
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already know,
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which is that good wages,
healthy food and safe housing
healthy food and safe housing
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are health?
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And for the rest of us,
for the citizens of this country:
for the citizens of this country:
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Will we demand accountability
to what we know to be true,
to what we know to be true,
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which is that our common sense,
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our common experience,
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makes us the experts
in what it takes to be healthy?
in what it takes to be healthy?
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This moment, as it turns out,
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is not about changing minds.
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It is about something more powerful.
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It is about changing the questions we ask
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and quieting the noise
to hear each other's answers.
to hear each other's answers.
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It is about the radical possibility
that we the patients,
that we the patients,
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we the physicians, we the caregivers,
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we the health care executives
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and yes, even we the people,
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that we agree.
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And it is now time --
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in fact, long overdue --
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for us to marshal the courage
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to hear those answers
and to act upon them.
and to act upon them.
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Thank you.
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(Applause)
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ABOUT THE SPEAKER
Rebecca Onie - Health services innovatorRebecca Onie is the founder of Health Leads, a program that connects patients to basic care and resources, such as food and housing, that are the root cause of many health problems.
Why you should listen
In 1996, as a sophomore in college, Rebecca Onie had a realization: The health care system in the United States was not set up to diagnose nor treat the socioeconomic issues that lead to poor health, and that health care providers are not given tools to address basic problems like nutrition and housing.
So, while still a sophomore, she co-founded Health Leads, a program that assists low-income patients and their families to access food, heat, and other basic resources they need to be healthy. With the additional insight that college volunteers could be recruited and trained into an elite group just like a college sport team, she found the people and skills needed to produce such an audacious idea. Since then it has grown tremendously, and now operates in Baltimore, Boston, Chicago, New York, Providence, and Washington, DC, and in the last year assisted over 8,800 patients.
In 2009, Rebecca was awarded a MacArthur “Genius” Fellowship.
Photo: Courtesy of the John D. & Catherine T. MacArthur Foundation
Rebecca Onie | Speaker | TED.com