Social norms about health, health care, and medicine:
Broadening the context for the national health care debate
Chauncey Conference Center, Princeton, NJ
July 24-26, 2008

Précis

As we approach the 2008 presidential election, there is lively discussion about reforming health care in the United States and various plans have been proposed with the primary focus concerning how we can improve access to care and who should pay for what. In the US, there are great economically- based inequities in the availability of care for the ill but also in the access to information, counseling and the wherewithal to maintain a healthy lifestyle, all of which should be central to a conversation about health and health care. There is no question about the need to eliminate these inequities. However, there is also a compelling and very much related need to evaluate existing health care practices and, if necessary, change and eliminate those elements of our health care system that are ineffective, gratuitous or deleterious. It may also be time to consider how social norms and our expectations concerning the power of medicine to fix all ills (or perceived ills) colors our expectations about the quantity and quality of health care to be universally provided.

An effective health care system should do more than just treat trauma, acute illnesses, and chronic diseases. It should include programs that promote lifestyle changes and other medical and non-medical practices that reduce the likelihood of trauma and the incidence of acute and chronic disease and thereby increase the number of year's people can anticipate living in good health. However, the preventive medicine elements of our health care also require examination to evaluate efficacy and utility. A good deal of our preventive healthcare expenditure is for screening and testing for cancer, coronary artery, heart and other diseases and treating well people with drugs to prevent these "diseases", some of which are normal products of senescence or markers of normal variability. There is no question that all-too-common false positives in standard screening procedures or "bad" scores in tests lead to considerable anxiety, more invasive and risky testing, and treatment of pseudo-disease or disease that will not progress.

How do the above factors contribute to the development of social norms about health, risks, health care delivery, expectations for cures, and so on? Do unexamined and unaddressed social norms complicate the ongoing debate about health care in the US?

For several years a small, multi-disciplinary group of scholars, the McDonnell Norms group, has been meeting to examine issues at the intersection of science, medicine, economics, and social norms. We are now convening a small workshop where the discussion will attempt to:

1. Identify those elements of our health care practice about which there is substantial controversy about efficacy and/or utility in treating and or preventing common causes of morbidity and mortality and thereby require evaluation.


2. Why are the recommendations of unbiased group(s) charged with performing evaluations rarely translated into practice? What are the barriers that seem to prevent the additional research needed to resolve currently unanswered or inadequately answered questions about the efficacy and utility of different disease treatment and prevention practices?


3. How can objective information about the efficacy and utility of established disease treatment and prevention methods be disseminated in a way that would be readily understood by the public?


4. Explore the value of using comparisons between health-care systems of different countries to evaluate the efficacy and utility of different elements (including norms) of the American healthcare system.