Keith Lindor - "People Want Health and We Sell Them Health Care"

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Apr 20, 2015
by Stuart Milne
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Keith Lindor - "People Want Health and We Sell Them Health Care"

Dean of College of Health Solutions at Arizona State University tells why more money should be spent on health instead of health care Keith Lindor at Session 548 | The Promise of Data: Will this Bring a Revolution in Health Care?

Keith Lindor firmly believes health care is a poor substitute for health, and by investing too heavily in the former, policymakers are missing the point.

While participating in Session 548 | The Promise of Data. Will this Bring a Revolution in Health Care?, the executive vice provost and dean of the College of Health Solutions at Arizona State University told Salzburg Global why the focus should instead be on what matters most: staying well.

“I think that most people want health - they don’t want to be patients, they want to be people,” Lindor said. “If we could do things to let them have health rather than require health care, they would be happier. What happens is people want health and we sell them health care.”

According to Lindor, the statistics show the country spending the most on health care has got its priorities the wrong way round.

“In the United States we spend a lot of money on health care, and yet we have very poor health. Our health outcomes rank around 30th in the world, and yet our expenditures are 60% higher than the next most free-spending country, so we get very little for the money that we spend.

“We spend about 95% of the dollars on health care and about 5% on health. When we look at the determinants of health, about 10% are health care, so we’re spending a lot of effort on a very short arm of a lever.

“As we look into the future, I think greater investment in health of a population will probably lead to better health of a population. Trying to continuously push on the health care end means that our ability to leverage mechanisms to improve the health of a population may continue to be fairly futile.

“I suspect that this would be a ripe topic for future Salzburg Global sessions because I think that other countries clearly do a much better job at investing in health, and hence have better health than we do in the United States.”

In addition to his roles at Arizona State, Lindor is also an international authority on cholestatic liver disease, which, like many chronic conditions, ties into the session topic of how best to use Big Data to improve health outcomes.

He said: “On the one hand, we’re faced with using genomic information or personalized medicine. An example would be molecularly-targeted therapy for liver cell cancer, in which we will typically use genomic information to determine what our potential targets are for chemotherapy. So that’s one end of the spectrum – very patient-specific and tumor-specific, even mutation-specific within a tumor.

“On the other hand, we’re dealt with population health issues that we do an inadequate job of facing. We don’t have vaccinations for Hepatitis C, a big problem, but we do for Hepatitis B.

"However, our application of vaccination programs for Hepatitis B is poor, particularly if we look at infants born to mothers with Hepatitis B. We don’t really do a good job of applying broadly the Hepatitis A or B vaccination for patients with chronic liver disease, or even people who are at risk of developing those infections.

“We have to deal with populations in which we can intervene in a much less expensive way, but more broadly, and hopefully save many lives by appropriate interventions in disease prevention.”

While Lindor says he had few clearly defined expectations before the session, he has found grounds for optimism that the work begun by participants at Schloss Leopoldskron will be taken forward.

“I think the biggest surprise is how valuable these sessions have been,” he said. “Part of it was the fluid nature of the program and how effective that was.

“The other part of this which has been so valuable is the diversity of the group. We see people from a variety of different countries, from different professions and vocational backgrounds.

“One of the biggest surprises has been the influence of the younger group that has been here. We have a lot of really bright younger people who think differently about data and the technology that uses it.

“I think that’s a group that’s going to really have to pave the way for what we do in the future.”


Keith Lindor was a participant at the session The Promise of Data: Will This Bring a Revolution in Health Care? The session is part of the Salzburg Global series “Health and Health Care Innovation in the 21st Century” and was held in collaboration with the Mayo Clinic, Arizona State University, The Dartmouth Center for Health Care Delivery Science, and in association with the Karolinska Insititutet. More information on the session can be found here: www.salzburgglobalseminar.org/go/548

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