Duke hosted its annual Health Forum Monday. This year’s theme was “The Emerging Healthscape: from Personalized Medicine to Population Health.” The event brought together attendees from the University and several state health agencies across the United States. A delegation from Taiwan also took part in the day’s discussions. The event featured a panel moderated by Dr. Karen Remley, Fuqua ’97 and the CEO/Executive Director of the American Academy of Pediatrics. Her key points are listed below.

1. Taiwan’s health system has some advantages over the United States’ system

Dr. Chi-Kung Ho, Taiwan’s deputy minister of health, outlined how his country’s 21-year old single-payer healthcare system works. Taiwan spends 6.2 percent of its gross domestic product on healthcare, compared to the nearly 18 percent the United States spends, while maintaining a high life-expectancy and low infant mortality rate. 

Still, the country faces some challenges. Its population will be considered “super-aged” by 2025, it has disparities in outcomes because of societal inequality and it faces a shortage of medical workers.

2. The United States needs to look at the “social determinants” of health

Although many reformers focus on the healthcare “delivery system,” panelists emphasized that the medical community knows that improving population health comes from addressing fundamentals, including housing, education and community infrastructure. 

Dr. Jewel Mullen, principal deputy assistant secretary for health in the U.S. Department of Health & Human Services, noted that this has been evident in Puerto Rico’s struggle with the Zika virus. 

“The entire response has been one in which I would say we have to look back on the social determinants of health—because we are talking about a virus that is spread by mosquitoes in a tropical environment, where people will start by telling you, ‘We have mosquitoes here all the time,’” Mullen said. 

Dr. Marissa Levine, the Virginia State Health Commissioner, explained that her state is using data to look at health through 13 social determinants. The state’s analysis codes each census tract by how easy it is to be healthy there, which will allow policymakers to develop action plans. 

Levine said her goal is to make Virginia the healthiest state.

“We will never get there unless we can figure out how to deal with these issues,” she said.

3. Health care resources need to be reallocated 

Many people are aware that the Affordable Care Act sought to expand coverage, which can lead to better population health, noted Christopher Koller, president of the Millbank Memorial Fund. However, much of the law focused on reforming existing payment systems. Koller said this needs to be expanded upon.

“Do we live longer in the United States? No, so there’s a lot of money that could be better invested in the system,” Koller said. 

He noted that some experts suggest increasing the amount spent on primary care, increasing the collaboration between healthcare providers and publicly grading healthcare providers by their outcomes for populations. When health care providers are judged by the outcomes of populations, they may invest more in areas such as preventative medicine, community health or other social interventions, like stable housing, peer counselors or job counseling. Ultimately, health can be improved if resources are invested in different areas.