To Gov. Ned Lamont and Connecticut Legislators:

Respect that the well-being of our minds and our bodies are cultivated by the families who raise us, the homes in which we live, the work at which we labor and the people with whom we surround ourselves. Each of us experience an “environmental impact” no less dramatic than the stress being waged upon our planet. It is high time that people and their welfare receive the same level of attention and concern.

H. Andrew Selinger, MD

Connecticut is notable for the dramatic disparity in social circumstances and physical environments that directly influence the flexibility for personal behavior choices. We pour money into a healthcare system that is ruthless in its pursuit of revenue stream and profit. And yet according to the Commonwealth Fund, the U.S. ranks 11th /11 developed countries for healthcare performance; last in health equity, healthcare outcomes, access and nearly last in administrative efficiency.

So how can “respect” for the social fabric of our lives influence our delivery and definition of quality primary care healthcare? Actions speak louder than words and individuals at different stages of life have different healthcare priorities. Creating and maintaining good health requires a lifetime of effort.

Children and adolescents need regular exposure to positive role models (parents, family members, teachers, significant people in their lives etc.) to help develop good habits and a positive self-image. Wellness care includes vaccinations, tracking physical, intellectual and emotional milestones and delivering essential education about substance abuse and safe behaviors. “Protecting” our young people’s health and well-being MUST include involving their families, their social communities, their schools and the individuals that staff them.

Young and middle-aged adults spend much of their daily life in a workplace setting. Employers need to understand and acknowledge the role they play in the health of their employees. Middle-aged adults need evidence-based care that includes management of highly prevalent conditions, such as diabetes, coronary heart disease, and high blood pressure. They also need education about healthy behaviors and medication management to reduce disease complications, improve quality of life and reduce costs. Beyond the trend to offer financial incentives for documented biometric screening and wellness encounters within the healthcare system, employers must work to promote and maintain healthy environments. The workplace is a “home” as much or more than where we live with our families. Our work habitat can provide for a constructive, enriching and self-actualizing experience or be a stressful, intimidating and destructive environment.

Senior citizens are living longer and healthier lives but longevity does not come cheaply. Senior citizens must receive support from outreach services that place “boots on the ground” to help them avoid social isolation and achieve their own stated healthcare goals. We must address both financial and physical barriers to good health. Especially for our seniors, “protecting” their welfare can only happen when society agrees to support them on … their … own … turf and acknowledging whatever boundaries and disabilities they may have.

Our vulnerable populations; whether they be poor, disabled or culturally different from the mainstream, require validation of their healthcare needs and an unwavering commitment to tackle the social determinants of health; the conditions in which people are born, grow, live, work and age. These include adequate education, available healthy nutrition, safe housing and communities, cultural competency, reliable transportation and income sufficiency. “Protection” of health for these populations must always seek to embrace the multiple complexities of their lives.

These goals —at every stage of life— are easily identifiable and readily achievable; their implementation will help achieve the highly valued quadruple aim of improved patient satisfaction, better patient access, increased clinician joy in work and lower overall per capita costs. We must pursue the goal of cultivating good health at home, in school, in the workplace and in our social and religious institutions. Continue to produce and deliver powerful public service announcements on TV, radio, in print and on social media that educate on topics of domestic violence, cigarette use, alcoholism and expand these to include topics of obesity, mental health, vaping and other important public health issues.

In Connecticut, we have created a template to deliver opportunities for better primary care healthcare for our citizens. Hundreds of stakeholders have labored for three long years to achieve this result. Our elected government has chosen to continue to “study” the final product and the opportunities it offers. Our efforts, intended to deliver primary care successfully as described above also seek to halt the erosion of patient trust in the healthcare system, elevate transparency to the highest ideal, and sustain the healing power of the therapeutic relationship.

Positive change happens when all the stakeholders involved hit a tipping point and seize the moment for change. The time to deploy a redesigned primary care healthcare delivery system cannot and should not be delayed.

Governor Lamont, Lt. Gov. Susan Bysiewicz, commissioners and legislators, be compassionate, but be bold, be thoughtful, but be determined and finally, look to the future and learn from the past. This is how our government will respect and protect the health of all the citizens of Connecticut.

H. Andrew Selinger M.D. is Chairman of the Department of Family Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University.

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