By MICHAEL PRAMENKO
The challenge is now defined. How do we simultaneously protect the health of Americans while also protecting our economy? Throughout human history, similar challenges have stemmed from war and infectious disease pandemics. The world wars of the 20th century and the Black Plague from hundreds of years ago left tens of millions dead.
Underlying these events are social and economic problems that either helped start wars or made the effects of a pandemic worse. The current pandemic is only the latest stark example.
There is now excellent data regarding the United States population areas that are bearing the brunt of coronavirus. Analyzing mortality data from the largest cities in America reveals a sharp contrast in COVID-19 mortality rates between socioeconomic classes here in America. People with chronic disease have a much higher risk of mortality from COVID. A closer look at the data reveals the heavy influence of poverty and race.
And, there is more to this than the obvious problems of social distancing in crowded high density low income neighborhoods. Low income, poor education, and racial injustice lead to chronic epidemics of chronic disease that fuel the fire of our current pandemic. These “flames” were present prior to the pandemic as the same factors continue to fuel crime rates, poor health, child neglect, and behavioral health problems.
The United States’ comparatively high rates of chronic disease and income disparity continues to dampen our ability to manage a pandemic or to effectively manage health-care costs.
Obesity, smoking-related disease, and substance abuse are major factors in the health of our country. Substance abuse includes alcohol abuse — an often overlooked but major burden with respect to human and financial resources. And, as so painfully demonstrated again this year, there is the chronic epidemic of racial injustice.
Progress can be defined by how well humans learn from their mistakes. One wonders what we can learn from the mistakes of this year and of the past several hundred years that left our country so distinctly susceptible to the effects of a pandemic.
While capitalism remains a foundational element of the United States, we must practice smarter capitalism to succeed in the 21st century. Currently, our self-destructive capitalism ignores the health effects of unhealthy products while saddling private business with the cost of caring for those problems. Self-destructive capitalism denies access to health care for the poor and middle class while directing them to the most expensive place on the planet to receive care — a United States emergency room. Self-destructive capitalism ignores the racial injustice that handicaps the very same workforce we need to succeed in a world economy. Self-destructive capitalism makes it difficult for a young minority child to realize the American Dream and shrinks the middle class.
Smart capitalism is not socialism. Smart capitalism realizes its true potential by prioritizing our most precious resource — human capital. It helps grow the middle class. Private industry, free to set up business anywhere in the United States, looks for a fairly healthy and well-educated population to set up shop. Otherwise, business would be flocking to the poorest neighborhoods in America for cheap labor. This obviously does not happen. Capitalism feeds off intelligence, innovation, and smart choices. Our local, state, and national economic policy should follow the same principles as a successful private business — healthy workforce — healthy workplace.
From a health-care standpoint, it makes great sense for a country to incentivize the health of the whole population. Not only does this improve the health of the workforce, but it also reduces the cost of health care to the businesses that are competing on a world stage. A great health-care system starts with access to health care and prevention of chronic disease. And, more broadly, the road to a healthy population is paved with education, an emphasis on a strong middle class, and racial justice.
Simply stated, our anemic investments in human capital impede our progress towards a full realization of our economic potential.
Right now, our human capital is growing more obese, abuses alcohol and drugs at an alarming rate, and remains saddled by the chronic effects of tobacco. Right now, some of our human capital is impaired by the systemic effects of racial injustice. Right now, educational opportunities are out of reach for some individuals.
In Colorado and Mesa County, our public schools are increasingly underfunded, disease-producing products like tobacco and alcohol are taxed much less than in most other places in the country, and we are only just beginning long overdue exploration of racial injustice in our community.
The challenge is well defined and attainable. The current crisis has a growing cost in lives and dollars: over 150,000 deaths and $3 trillion in additional debt. Smart investments would have markedly reduced these human and financial costs. The return on investment is huge. Otherwise, we can’t expect a better response to a future global pandemic, lower health-care costs, less crime, or less inequality.
We are losing more lives and spending much more by ignoring the chronic epidemics that fuel the pandemic. Penny wise and pound foolish, we can do better.
Michael J. Pramenko M.D. is the executive director of Primary Care Partners. He is chairman of the Board of Monument Health and is a past president of the Colorado Medical Society.