When Lauren Taylor and Yale professor Elizabeth Bradley published The American Health Care Paradox in 2013, policy makers and public health scholars praised their work.
This year, Brown University Medical School will make the book, which contradicts conventional wisdom on both the right and the left of the health care debate, required reading for all incoming students.
The success is heady stuff for Taylor, a recent Yale graduate and former All-American lacrosse player in her 20s. Still, she didn't just want to criticize the health care system, or write about changing it; she wanted to make it better. So she came to Harvard Divinity School to get an understanding of the forces that shape individuals, organizations, and societies.
"My time here is about trying to understand the language and the values of faith communities so that we can take those lessons to broader swaths of the country," she says. "Trust, faith, compassion, and interdependence are critical to change the system in a place where a lot of people think 'I don't want my money to be taken in tax dollars to go to that other person because they'll probably misuse it.' "
Anyone who cares about the health care crisis in America is familiar with what Taylor calls "the paradox."
The United States spends much more on care than any other industrialized nation in the world—nearly $8,000 per person in 2009 versus less than $4,000 per person in most developed countries. Yet the U.S. lags on a wide range of basic measures of health: the country is 25th out of 34 Organization for Economic Cooperation and Development (OECD) nations in maternal mortality; 26th in life expectancy; and 31st in infant mortality.
In The American Health Care Paradox, Taylor and Bradley crunched data from all OECD countries and found that investments in social services—from nutrition programs, to housing, old age pensions, job training, and education—have an enormous impact on health.
When they added spending per capita on social services to that of health care and looked at the total of the two, the United States actually landed in the middle of the pack. Suddenly, America's middling health care outcomes started to make sense. Moreover, they found that where a country puts its resources matters. Nations that invest more in social services than health care tend to have better outcomes and lower costs than those who divide their resources the other way around.
"The average OECD country spends twice as much on social services as they do on health care," she says. "In the U.S., though, we spend twice as much on health care as we do on social services. So we have this really distinct allocation pattern and a really distinct outcome pattern. It's a way of understanding health that doesn’t get a lot of attention in the discussion about the cost of care."
Critics of Taylor and Bradley's more holistic perspective charge that it muddies the waters. Discussions about health care should center on doctors and hospitals, disease and treatment.
Remove death and injury due to violence and accident, they say, and the U.S. has the best system in the world. Moreover, a more expansive view of health and how to create it is just an excuse to expand a welfare state that has already turned nearly half of all Americans into "takers" rather than "makers."
According to Taylor, the data do not support these claims.
"If you want to focus only on medicine, how do women fare in childbirth?" she asks. "The overwhelming preponderance of American women give birth in hospitals, but we still don't do well on maternal mortality. And we can deny people social services, but they'll still seek care, usually in an emergency room, which is the most expensive—and often uncompensated—kind of care. Any way you look at it, our system is deeply influenced by other factors that impact someone's life before they ever set foot in a hospital."
It was the need to understand those "other factors" —particularly culture, ethics, and belief—that brought Taylor to HDS in 2012. Taylor had immersed herself in policy, but ultimately realized that she needed a bigger frame through which to understand the health care system and the resistance to—and desire for—change.
"The book got me to a place where I said, 'Man, this is not just about ineffective policy. This is about something deeper. It's about culture and it's about values,' " she says.
At HDS, where she is an Elizabeth H. Monrad Scholar, Taylor considers the American "mythology" of the "rugged individual," as well as the ways in which capitalism has become a sort of theology. Both aspects of our culture, she says, can obscure the collective nature of health.
"Health is not something that we can achieve independently," she says. "We see this with vaccinations. You say, 'I don’t want to get my kid vaccinated.' Then he gets measles. Then my kid gets measles. It's not just a personal choice. It affects me and my kid and my family's health and pocketbook."
While Taylor has reservations about social movements that are too closely identified with particular religions, she says that one thing she's learned at HDS is the power of religious communities to foster precisely the values needed to effect the type of transformational change that real health care reform would entail.
"Religious communities really recognize interdependence in a way that the rest of the country, and in many ways the rest of the culture, don't," she says. "If someone is ill, you take them lunch, you take them dinner. They're important to you because you're both children in the eyes of God. There's a recognition of interdependence and responsibility and a really unique sense of trust."
In the years ahead, Taylor plans to take a newfound understanding of religion and a more developed vision of ethics into her work on global health. She says that the knowledge and wisdom she’s gained at HDS will be invaluable as she goes back into the world to make a difference.
"I've worked in Ghana. I've worked in Kenya. I've worked a little bit in China," she says. "When you go into the field and you try and build a health system, in most low- and middle-income countries, you're not going to do it without encountering faith communities and religious institutions. My ability to engage with them now will help me make progress wherever I go."
—by Paul Massari