Salus Health Care Forum: November 5, 2025

Bill B

We have a sociologist attending this forum who has thought a little bit about the issue of community and support. Craig, do you have some thoughts and comments at this point?

Craig

Well, this goes back to Jeremy’s challenge to us. We don’t deal with community health, with public health, with population health very effectively in this country. And so much of health depends on public policies that have nothing to do with the health care system. And it’s those that shape differentials among communities, across communities, and those that need to be addressed through broader social policy initiatives, which are, it’s hard to measure their impact. But we know early childcare, for example, a high-quality childcare has huge effects on child development, child growth, and later life success. So, we need to go beyond the health care system to think more broadly about social policy.

Jeremy

I agree that the challenge is framed better in this report than the solutions. However, it is worth noting that they really emphasize whole population health. It does seem that the term, population health, which was coined in the 1990s, is gathering steam. In some ways, the term “population health” is an attempt to pull Craig’s world, the primary health care world, the behavioral health world, and the public health world all together. The evidence should be looked at, because of the early childhood impacts that Craig’s is bringing up. Most of us would anticipate that childhood health has outsized impacts later on. This seems to be the case, at least from the evidence we’ve looked at on the negative side. As we’ve brought up in prior Salus forum discussions about adverse childhood experiences, we know that there’s a very magnified negative effect. However, as Craig has brought up, and I think others have mentioned, the positive magnified impacts don’t get studied very much and don’t seem to get funding. We’re much better at defining the problems.

Bill Bergquist, it reminds me of the field of psychology. In the 20^th Century, psychologists focused on psychopathology, whereas the positive psychologists and the humanistic psychologists of the 21^st Century have really been expanding the positive aspects. They do strengths-based assessments, much as we’re been talking about asset-based assessments of rural health care systems.

There’s a lot of common language that started to sound similar to me across these fields, which I find encouraging, and yet we are still at cross purposes because all our funding happens in separate buckets. What I understood from this NASEM report was that for the infrastructure of public health, we spend $98 billion a year. And we spend $70 billion a year doing spine fusion. The Loewen Institute has concluded that half of those spine surgeries are unnecessary. That’s the degree of distortion that we’re dealing with.