A Rationale and Framework for Activating Employers as Agents of Change in the Implementation of Lifestyle as Medicine

Abstract

The fuel of a nation's wealth is the health of its people. Not only must we lower the overall cost burden of sick care, we must reduce the very need for sick care. We must work towards a future where transformation…informs the creation of a true health ecosystem-an ecosystem of informed and self-directed wellbeing." Robert Sundelius 1 Achieving the vision of human flourishing that Sundelius envisions will require a fundamental shift in our current approach to healthcare. 1 Many would argue that the transformation is long overdue. Chronic diseases take an enormous toll on individuals' quality of life and are a key driver of healthcare costs-in part because 40% of U.S. adults have 2 or more chronic conditions. 2 The Centers for Disease Control reported that chronic health conditions account for 90% of our nation's $4.1 trillion in annual healthcare costs. 2,3 Even more troubling is the fact that the prevalence and burden of chronic diseases continues to rise, often disproportionately affecting individuals from Black and Brown communities. A recent study reported that, from 1999-2020, 1.63 million excess deaths and more than 80 million excess years of life lost were experienced by Black Americans compared to white Americans, with cardiovascular disease being the leading driver of excess mortality. 4 Declining life expectancy in U.S.-now at lowest since 1996 2 -is partially attributable to cardiovascular disease, and young adults represent growing proportion of cardiovascular disease events. 5 The prevalence of cardiovascular risk factors (most notably diabetes and obesity) among adults aged 20-44 increased from 2009-2020 in the U.S.-and in particular among Black, Hispanic, and Mexican Americans. 6 Recent modeling studies predict an increase in diabetes in the U.S. among individuals younger than 20 that is expected to disproportionately impact Black youth. 7 Despite spending more per capita on healthcare than other developed nations, our current healthcare system is failing-and that failure is captured in Americans' sentiment of widespread dissatisfaction. In a recent Harris Poll, 60% of U.S. adults gave the healthcare system a grade of C or worse. 8 There is, therefore, an urgent need for increased implementation of lifestyle change as medicine, but barriers remain (eg, current reimbursement models). The predominantly fee-for-service healthcare model in the United States is riddled with perverse incentives that lead to a prioritization of pharmacological and procedure-based interventions rather than addressing root causes. 9 What is clear is the need to redefine healthcare-to move away from a system of sick care to a new model focused on centering equitable access to a healthy lifestyle as a key pillar of prevention, management, and treatment of chronic diseases that are consuming far too many healthcare dollars and robbing us of precious time with loved ones. Lifestyle modifications (eg, plant-based diets, physical activity, adequate sleep, strong social connections) can prevent, treat, and in some cases re...