Fred Fortin’s discussion of “Soft Power” suggests the potential for the US to lead by example in the healthcare arena, whereas it has lost influence to a significant degree in other areas, thanks to dropping behind on environmental issues and championing democracy.  Given the amount of money the US spends in healthcare, and its leadership in technology applied thereto, the potential might seem great.

The problem is that our “lead” in healthcare seems to be mainly in our proven ability to spend far more per capita than any other nation on earth, while getting far less return on our investment in terms of the health of our population.  The one area where we might offer leadership is in proactive health management (PHM), where we have a large industry devoted to reducing the incidence and prevalence of disease and injury, as well as managing existing chronic diseases in order to reduce their crises, complications, and worsening over time.

All other nations in the world share problems related to out-of-control increases in the incidence and prevalence of disease and injury, either infectious diseases in underdeveloped countries, or chronic diseases in developed.  The reason we have not created leadership in this arena is that we have not proven to be cost-effective in doing anything about the problem.

Our government keeps coming up with the same conclusions, and publishing them for all the world to read, that disease management, as practiced here, has not proven to work.  Moreover, the majority of PHM investments are still evaluated in terms of reducing the rate of increase in healthcare costs, where many other countries in the world, as well as many employers in this country, have long since added the far greater returns that are being achieved in improving workforce productivity and performance.   Besides, preventing chronic diseases will clearly save a lot more money than managing them.

The rest of the world is often leading the US.  Because insurers, employers and the government (plus taxpayers, of course) share the burden of paying for sickness care, most of the wellness, risk reduction and disease management efforts we have been involved in for the past few decades have been aimed at controlling sickness care costs.  They have usually been piecemeal, rather than strategic, and looking for short-term rather than lasting payoff.

In Europe, plus countries like Australia, South Africa, etc. that are equally well “developed”, governments often bear the burden of sickness care costs.  This does not mean that employers are unconcerned with employee health, however.  For one thing, many employers bear part of the burden, or offer private health insurance for workers when use such fringe benefits to recruit and retain the talent they need.  And for another, they have found that healthier/happier employers are significantly more valuable to their employers than are unhealthy/unhappy ones.

European firms, particularly those in the UK, have found that employee health and well-being efforts pay off in significantly reduced absence rates, as well as reduced productivity impairment when at work (“presenteeism”).  Dramatic reductions in turnover have been achieved, along with on-the-job injuries and sick leave costs.  And those that have looked have often found positive impacts on revenue as well.

Healthier/happier employees tend to deliver higher quality products and services, increasing customer satisfaction and loyalty.  Their enthusiastic recommendations of their firms’ products and services, along with the word-of-mouth “advertising” by more satisfied customers have been credited with significant increases in new business and added revenue.  While many other factors in the handling of employees contributes to these same results, any health improvement effort that does not is likely to miss a substantial amount of value already being delivered.

Until and unless the US qualifies to and actually takes a leadership role in the measurement and management of all the factors that affect employee productivity and performance, it will not be entitled to such a position in proactive health care, any more than it is in reactive sickness care.  While our country enjoys one of the highest productivity levels in the world, that is more due to technological innovations and working employees harder than most other countries.  When it achieves such pre-eminence via managing employee health and happiness better than anyone else, it may justify a leadership position in proactive health as well.