What If Our Health Care System Kept Us Healthy?

Mar 18, 2014
Originally published on April 20, 2015 2:07 pm

Part 3 of the TED Radio Hour episode Solving It.

About Rebecca Onie's TED Talk

Health advocate Rebecca Onie describes how our health care system can be restructured to prevent — and not just treat — illness.

About Rebecca Onie

I believe that at the end of the day, when we measure our health care, it will not be by the diseases cured, but by the diseases prevented. - Rebecca Onie

In 1996, college sophomore Rebecca Onie had a realization: The U.S. health care system was not set up to diagnose or treat the socioeconomic issues that lead to poor health, and that health care providers are not given tools to address basic problems like nutrition and housing.

So she co-founded Health Leads, a program that uses a corp of trained college students to assist low-income patients to access food, heat and other basic resources they need to be healthy. The program now operates in Baltimore, Boston, Chicago, New York, Providence, and Washington, D.C. In 2009, Onie was awarded a MacArthur fellowship.

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About 10 years ago, when she was a student in Boston, Rebecca Onie started to volunteer at a local hospital. And the more time she spent there, the more she realized that the health care system was ignoring an obvious problem. Rebecca picks up the story from the TED stage.


REBECCA ONIE: The doctors, it seemed, never really had enough time for all the patients, try as they might. And over the course of six months, I would corner them in the hallway and ask them a sort of naive, but fundamental question. If you had unlimited resources, what's the one thing you would give your patients? And I heard the same story again and again, a story we've heard hundreds of times since then. They said every day we have patients that come into the clinic. Child has an ear infection. I prescribe antibiotics, but the real issue is there's no food at home. The real issue is that child is living with 12 other people in a two-bedroom apartment, and I don't even ask about those issues because there's nothing I can do. I have 13 minutes with each patient. Patients are piling up in the clinic waiting room. I have no idea where the nearest food pantry is, and I don't even have any help.

RAZ: So Rebecca came up with a plan. And she started something called Health Leads, and the purpose was to help patients have the infrastructure at home, not just to get better, but to stay healthy.


ONIE: And we asked, not what do patients need to get healthy - antibiotics and inhaler medication - but what do patients need to be healthy, to not get sick in the first place. And we chose to use the prescription for that purpose. Doctors and nurses can prescribe nutritious food, heat in the winter and other basic resources for their patients the same way they prescribe medication. Patients then take their prescriptions to our desk in the clinic waiting room where we have a core of well-trained, college student advocates who work side-by-side with these families to connect them out to the existing landscape of community resources. So just a few miles from here at Children's National Medical Center, when patients come into the doctor's office, they're asked a few questions. They're asked are you running out of food at the end of the month? Do you have safe housing? Is the family living in a shelter?

Are you worried about food? Are you worried about housing? Do you need help getting a job? And when the doctor begins the visit with the patient, they can now talk about the fact that, you know, not only does he need a refill for his inhaler for his asthma, but he also needs help getting his heat turned back on so that the cold air in his apartment doesn't keep triggering his asthma. And when they talk about that, the doctor can actually act on it, right. She can prescribe heat.

RAZ: So that patients, like, show up at the desk and they say I've got a prescription for heat. And then what happens? I mean, can the volunteers, like, literally call up utility companies?

ONIE: They literally call up utilities companies, and a lot of utilities companies actually have plans for people who can't afford to pay their bills. And they'll be able to work with the patient to figure out a payment plan over time. So yes, it's using the clinic to bridge patients from the doctor's office directly to those resources that they need to be healthy.

RAZ: I mean, it's almost like a reimagination of how doctors and patients should and will maybe interact.

ONIE: And I think that's the real transformation is how do we reimagine health care so that the doctor can prescribe a cardiologist for a patient and the doctor can prescribe getting heat for the patient? That's the whole notion is how do we make being able to refer a patient to the utilities company as integral a tool to the way health care is delivered as referring the patient as to the ophthalmologist?

RAZ: What's so interesting to me about this idea is that it's actually kind of simple.

ONIE: One of the - when I talk about this idea, people will often come up to me and say, you know, no offense, but it's really obvious. And - which is like, to me, the ultimate compliment, but the funny part is to say, well, no offense, but then why aren't we doing it?


ONIE: My belief is that it's almost too painful to articulate our aspirations for our health care system or even admit that we have any at all because if we did, they would be so removed from our current reality. But that doesn't change my belief that all of us, deep inside, share a similar set of desires. That if we are honest with ourselves and listen quietly, that we all harbor one fiercely held aspiration for our health care - that it keep us healthy.

RAZ: So after you gave your talk, what happened? Like, did people, all of a sudden, start contacting you and saying we want to do this at our hospital, and how can we start this?

ONIE: Yeah, the TED talk was the most extraordinary opening of floodgates that we could have possibly imagined. I think over the past couple of years, we've had 850 expansion requests for Health Leads from health systems and health departments and hospitals and doctors' offices all across the country. What we hadn't anticipated was how powerfully we were articulating vision for health care that was already out there, but just hadn't been made real yet.

RAZ: What do you hope that the health care system looks like, especially for poor people, in like, 10 years?

ONIE: Yeah, I'd love for us to not even having this conversation in 10 years. When you go into the doctor's office, the doctor asks you whether you need a set of basic resources to be healthy. And when you, as a patient, say yes, then it's just a prescription or referral away. And that this is just how care is provided. It's so much a part of how health care is that we don't even have to talk about it anymore.


ONIE: You know, the way that I think about this is that health care is like any other system. It's just a set of choices that people make. What if we decided to make a different set of choices? What if we decided to take all the parts of health care that have drifted away from us and stand firm and say no. These things are ours. They will be used for our purposes. They will be used to realize our aspiration. What if everything we needed to realize our aspiration for health care was right there in front of us just waiting to be claimed? I believe that at the end of the day when we measure our health care, it will not be by the diseases cured, but by the diseases prevented. It will not be by the excellence of our technologies or the sophistication of our specialists, but by how rarely we needed them. And most of all, I believe that when we measure health care, it will be not by what the system was, but why what we chose it to be. Thank you.


RAZ: Rebecca Onie is the cofounder and CEO of Health Leads, which now serves about 14,000 patients a year. You can see her entire talk at TED.com. In a moment, fixing the criminal justice system. Stay with us. I'm Guy Raz, and this is the TED Radio Hour from NPR. Transcript provided by NPR, Copyright NPR.