This is Laura Dedo with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Dr. Lawrence Moss,
president and c e o of Nomura's Children's Health. Dr. Moss,
it's a pleasure to have you on the podcast today.
Thank you, Laura. Pleasure to be here.
Now,
I know you've recently released a new ebook called Finding Health by Looking in
the Right Place. Could you tell us a little bit more about it?
Uh, happy to. I maybe should start with the,
the underlying reason that I wrote this and that's that my continued
observation that in this country we tend to equate health with
medical care and we try to fix problems related to
help by throwing more and more medical care dollars at the problem.
And this book is a response to that and provides my, my point of view,
in fact, not just my point of view,
my observation and statement of the fact that health is mostly
not medical care.
We know from decades of research that health is about 80%
other factors such as food security, safe housing, freedom from violence,
good education, and about 20% medical care.
Nemours is an organization that provides medical care to children.
However,
we're an organization that sees ourselves in the business of creating health,
not just delivering medical care.
And that means getting involved in all of those other things.
Absolutely. That's fascinating and certainly such an important, uh,
area to be focused on right now.
I can imagine that there are so many different health issues that your patient
population is going through, especially coming out of the pandemic.
I know that the book subtitle is how understanding what actually Creates Health
Can Fix U US healthcare.
Could you tell us a little bit more about what that means in what really, uh,
you're getting at with some of the, these big themes and topics of the book?
Uh, of course.
Let me start with a bit of a personal perspective or a personal
story. Um, by training, before I became CEO of Nemours,
I'm an academic pediatric surgeon and I spent my career for 25
or 30 years prior to this role,
taking care of kids with extraordinarily complex problems including
complex congenital anomalies, advanced cancer, things like that.
So call that the 1% of the 1% in that
aspect of healthcare, or I should say medical care,
this country does extraordinarily well.
And if you're unfortunate enough to have a child with those kind of problems,
this is hands down the place on the planet you wanna be. However,
if you're the other 99.9% looking for health that
doesn't need complex, tertiary quaternary care,
this is arguably the worst place on the planet to be.
Or at least in the developed world,
the United States spends a massive amount on medical care, however,
we have among the worst health illnesses of any developed country.
And we tend to say, oh, that's because healthcare is so complicated.
This book is an effort to demonstrate that health and the pathway
to health is not that complicated.
It actually includes things that all of us are familiar with and all of us
experience in our lives every day.
And that is really the core message I wanted to send to people.
That's such an important message and so interesting to hear, um,
about just really being able to dig deep into these challenges and really
understand and, um, decompress some of the, the big issues in healthcare today.
And I'm wondering,
is this just a healthcare industry problem or are there roles for other sectors
to really pitch in and be part of the solution?
Could you talk through that a bit more?
Well, great question. No,
it's not just a healthcare industry problem and frankly it's not a healthcare
industry problem. It's a more global problem than that. Now,
I like to say that fixing healthcare in the United States is not complicated at
all. It's actually quite simple and we just need to do three things. Number one,
understand what health is.
And that's about realizing that health is 80% not medical care and realizing
that we need to get involved in those things. Number two, pay for health.
In the United States,
our healthcare enterprise is a roughly 4.1 trillion per year entity.
And almost every penny of that goes to the opposite of what we
want, which is health. We don't pay for health in this country.
We pay for volume of medical care delivered and complexity of medical care
delivered. Therefore we get what we pay for.
We deliver more than any other nation on earth.
We charge more than any other nation on earth, and we get,
and that's exactly what we get is an awful lot of medical care delivered and not
health. And finally, bullet number three is start with children.
And I think it's important for society to realize that children's health care
is not only about children's health,
it's about the health of our entire society and the roots of all
of the problems that we deal with in our adult population. Cancer,
heart disease, diabetes, poor workforce, productivity,
all of those start in childhood and can be addressed far more effectively
in childhood than they can after the horse is out of the barn.
That's such a great point and so important to keep in mind as we're thinking
about the global healthcare crisis and especially the healthcare system in the
United States. I know the pediatric population certainly gets overlooked, um,
quite often, but as you mentioned, it's, you know, those, uh,
health issues and habits and, and all sorts of other things, um,
really can make a big difference if you're starting as a child. And you know,
I know too that you have a chapter on health and transportation within the book.
What's the connection there and how can transportation issues, uh,
bring about changes in health?
So transportation might sound like kind of an esoteric issue that's
somewhat distant from health, but actually it's directly related to health.
Um, in a most obvious way,
nobody can get medical care unless they can get to the appointment in the first
place. And that is an enormous burden for a huge proportion of our population.
Children in the United States have their medical care funded by
Medicaid in 54% of cases,
which means the majority of children in the United States come from
economically limited circumstances. And in that population,
transportation can be a huge issue,
but the issue of of less than optimal access to transportation
goes far beyond simply being able to get to medical appointments.
It relates to being able to get to school,
being able to get to a supermarket where there's fresh and healthy food,
being able to get to daycare,
a parent being able to get back and forth to work and maintain employment.
So transportation runs pretty deep when we talk
about health, not just medical care.
Got it.
That's such an important point and definitely makes sense when you talk through
it that way. I, I really appreciate your expertise in, in such a,
a great perspective to have. Now I know another chapter,
you talk about nutrition having supernatural effects.
In what way does that occur?
Nutrition in many, many ways is really the root of health.
And when there are nutritional problems in early childhood
that subsequently leads to obesity,
to diabetes, to heart disease, to a higher risk for cancer, frankly,
to almost every adult disease that we see in the population.
And when I talk about children being a lever of impact,
tiny and very inexpensive changes in nutrition and other
areas that happen in early childhood can have profound influences
later in life in health trajectories. You know,
when we look at the profound health problems in our adult population, we can,
and we do spend massively trying to change those health trajectories
and we spend a massive amount for a little bit of effect
in early childhood.
We can spend a tiny amount for a huge effect
as a society. We'll,
we will readily spend a million bucks trying to change the trajectory of a
group of people with diabetes when a hundred bucks in early childhood could be
far, far more effective.
That's fascinating to hear and definitely such an interesting point by you and,
and certainly I, I love that narrative and analysis in looking at how,
especially for kids with diabetes, it makes a really big difference in,
in I'm sure many other, um, health issues as well.
I know many of the areas that you described are areas in which adult and
children can protect their health. Is that true?
Are there differences in how things can impact children as compared to adults?
Well, sure there are differences and children have some, uh,
susceptibilities that are, that are not relevant to the adult population,
although, you know,
I would put those issues as far down the list and relatively minor.
The overarching issue is doing the simple thing
that ensure good health and a good health trajectory in children
pays dividends. You know, I've,
I've never met an adult who didn't used to be a child.
So even though children are 15% of the population and even though they
represent only 7% of the nation's healthcare expenditures,
they ultimately are the key to making changes,
profound changes across society. When we make changes in childhood,
trajectories are changed and all we have to do is wait until those
kids grow up and that becomes the adult population. And even more,
there's the added benefit and we've seen this with experimental evidence that
when we change health behaviors and health beliefs early in childhood,
those kids grow up,
become adults and pass those behaviors onto their children
without any further intervention from us.
So it's an enduring and pervasive impact.
I see your point. That um, definitely makes a lot of sense. And you know,
I can imagine being able to reach children effectively takes a,
a real group effort, a village if you will, um,
from the parents to the caregivers to the community and then the health system.
Um, for the hospital and health system leaders who are listening to this podcast
today, what is most effective for them? How can they really influence, um,
and impact the children within their community most effectively?
Well, I'll speak to my peers in the children's hospital industry cuz I think the
issues may be a little bit different for adult hospitals,
but I believe very strongly that children's hospitals need to
become the stewards of children's health in this country.
Not just the place sick children go for medical care will always be the place
where sick children go for medical care.
But our obligation and our opportunity is so much greater than that now.
We are experts at delivering medical care. We're not experts in housing,
food, security,
education and all those other factors that predominantly determine health.
However,
we can be the conveners of experts in those areas that bring everybody
together to do what you say takes a village,
which is create a healthy trajectory for all children in this country.
Thank you so much for, for describing that for us.
I think that's so helpful and definitely, um, is important for all, uh,
children's hospitals in particular, but in others to just keep in mind. Finally,
before we wrap up,
what is the main thing you want readers to take away from this book?
Let's keep it simple, Laura. I want people to take away three things.
The prescription to fix healthcare, understand what health is,
pay for health, start with children, and that's it.
Simple, straightforward. I love it. Thank you so much Dr.
Moss for being here today. This has been such a fun conversation.
I'm really excited that you're able to launch this ebook and I know anyone can
download the book for free of charge at http slash slash
nemours.org/ Larry Moss leadership.
Thank you so much, Laura.
It was a privilege to talk with you and I appreciate Becker's interest in the
work that we're doing and we look forward to continuing to contribute to the
health of children.