EDITOR’S NOTE: I’ve been working with Michelle Jenck for over a decade with Tillamook County Wellness – that started out as the “Year of Wellness” – but that’s another story. Michelle and I were recently talking about the crisis and chaos being faced by healthcare right now – everywhere, but especially hitting our rural health providers. There are so many influences on the delivery of healthcare, but most importantly is the focus on treating the sickness instead of a focus on prevention. Michelle does the work advocating for upstream interventions, individual health outcomes and innovative programs that can really make a difference. She’ll be writing about how we can work to make changes to help our communities acheive healthy quality lives.
By Michelle Jenck, M.Ed.
People ask me why I “waste my time” attending meetings, serving on boards, and working on changing policies.
I get it. Progress in system and policy change feels glacial. The question I always come back to, though, is: What’s the alternative? Because if we step back, we’re not opting out of the system. We’re just leaving it exactly as it is. And, in many instances, it isn’t working very well. At all.
The outcomes we’re seeing – rising healthcare costs, housing shortages, poor education outcomes – aren’t random. They are the result of how our systems are functioning.
And systems are shaped by policy.
We tend to focus on individual choices. Eat better. Exercise more. Make good decisions with your money. And those things matter. But they only go so far when policies and systems aren’t set up to support or maximize those choices.
If there’s no safe place to walk or bike, how do you stay active?
If healthcare mostly shows up after you’re sick, how do you stay well?
If there is no housing, how do you find something you can afford, so you can get ahead?
That’s not just about personal responsibility. That’s about design.
Like a lot of people, I used to assume there was someone out there whose job it was to make sure policies worked the way they should. Someone with a clear plan, pulling the right levers.
But that’s not really how it works. Policy gets shaped by people – people who are often doing their best, but often people (politicians) who are not experts and who have to rely on input from others to understand the problems they are trying to solve.
And here is the problem. The people who consistently show up to shape policy are often the ones with the most time, money, or something to gain financially. Rarely are these influencers looking at challenges from a holistic view. Hence solutions are often off the mark. Meanwhile, the rest of us, the ones living with the outcomes, are left to live with the unintended consequences of faulty design.
Take healthcare as an example. We spend about $5 trillion a year in this country. That’s taxpayer money. Yours, mine, everyone’s. And, even with all that spending, people are still struggling with chronic illnesses, months to see a doctor and limited access to insurance coverage or sky high premiums and copays.
I don’t have a clear answer for where all that money is going but I can say this with confidence:
we are not investing enough in prevention. It is not incentivized. We only pay for things after people get sick. Why? That’s a policy choice.
Here’s what I’ve learned. Most systems aren’t “broken” in the way we might think. They’re doing exactly what they were designed to do. The problem is, they weren’t designed with long-term outcomes in mind, or they don’t take into account some of the variables that contribute to unintended outcomes.
Real change starts with people asking better questions like:
What’s actually driving outcomes?
What’s getting in the way?
And, what would it look like if we did things differently?
You don’t have to be an expert to be part of that. Sometimes it’s as simple as showing up at a meeting, asking questions, reading an article, or sharing what you’re seeing and experiencing.
I still get frustrated – change can be slow and messy – but stepping back doesn’t fix anything. If we want different outcomes, we have to be willing to step in. That’s why I stay involved, and if you care about where we’re headed, I hope you will too.