David Kindig: Health Care Reform is more than medical services
Dr. David Kindig
On Tuesday January 20, 2009 Dr. David Kindig offered the second annual Harold Wise lecture as part of our Social Medicine Rounds series. The Wise lecture is organized the Residency Program in Social Medicine Alumni Committee. His talk was entitled: To: President Obama, From: Harold Wise, MD, RPSM Founder, Re: Beyond Health Care Reform. Dr. Kindig has kindly given us permission to post his presentation which can be downloaded here. It should not be reproduced without his consent.
Dr. Kindig began with some memories of Harold Wise, a Canadian physician born in Hamilton Ontario in 1937. After receiving his MD degree at the University of Toronto in 1961, Dr. Wise completed an Internal Medicine internship at the Kaiser Permanente Foundation Hospital. In 1964 he moved to Bronx and completed his Medicine residency at Montefiore. He then served as Director of Ambulatory Services and Home Care at Morrisania City Hospital, a New York City hospital affiliated at the time with Montefiore. In 1969 he became the director of the Dr. Martin Luther King Jr. Health Center, one of the first OEO (Office of Economic Opportunity) Community Health Centers in the US. Faced with the problem of finding well-trained clinicians interested in working in underserved areas, Dr. Wise created the Residency Program in Social Medicine. He passed away in 1998.
Dr. Kindig then discussed his own path to the Bronx. As a pediatrics resident at the University of Chicago he had been told that spending a month working at a community health center was “not a legitimate PGY-2 activity.” He was becoming increasingly politically active at the time and became interested in pursuing other paths in medicine. He met up with Harold Wise who convinced him to come to the Bronx and develop a “Social Pediatrics” residency program. Dr. Kindig moved from Chicago to the Bronx both creating the residency program and becoming its first graduate in 1971. He went on to have a distinguished career in academics and government service. He is currently Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin-Madison, School of Medicine. He also serves as Senior Advisor to the Wisconsin Public Health and Health Policy Institute.
His talk focused on the need to move beyond simply reforming health care in the United States. Insuring all Americans and providing them with health care are two necessary and important steps for the new Administration in Washington. But they are not enough. True health reform would require addressing the multiple social determinants of health. He discussed how the book Why Are Some People Healthy and Others Not? The Determinants of Health of Populations had been an epiphany for him. He had come to see that curative medical services were of limited value in addressing social disparities and that spending more on such services might actually reduce the overall health of the population. He briefly reviewed some of the recent evolution of thinking on population health and spoke about his own work in conceptualizing reimbursement systems that would pay for population health. His concepts are outlined in his book Purchasing Population Health (available on Google Books) and in a 2006 JAMA article A pay-for-population health performance system.
Currently, Dr. Kindig is active in the Robert Wood Johnson Health & Society Scholars Program and the Population Health Initiative at the University of Wisconsin. At the Population Health Institute he leads an initiative to make Wisconsin the healthiest state and he shared some of that work with us. The project produces an annual report card on Wisconsin health. The 2007 report card noted that while health in Wisconsin was improving it was not improving as fast as other states. The state was graded B- overall for health and D for addressing health disparities. The program is moving beyond merely grading the state to better understanding the determinants of health and then to suggesting specific evidence-based actions to address each one. The work of the program seemed embued with a very political sense of making health statistics understandable to the people who could actually influence public policy.
It is impossible to comment on the talk without mentioning the spirit of optimism generated by the inauguration earlier in the day of Barack Obama. Rounds took place at the Cherkasky auditorium where some five hours earlier hospital employees had watched President Obama sworn in. It in words of Montefiore President Steven Safyer it was a moment of Jungian synchronicity.
posted by Matt Anderson, MD
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