I just published an updated version of a recent white paper on why large-scale population behavior change is the central challenge of the American healthcare system and what the contours of a paradigm will be to address it. From the paper:

To say the current healthcare paradigm is challenged by the task ahead is an understatement: trying to address the totality of a massively complex biological, psychological, social, economic, and behavioral dynamic with an acute care model at the tip of the spear, a chronic care model in the middle and a one-size-fits-few preventive care model at the base of the pyramid is very hard (if not unrealistic). The U.S. Department of Defense, with their recently articulated principle of “total force fitness,” is at the forefront of defining what a new paradigm will need:

Achieving total force fitness involves…a system that addresses an integrated whole person, including family, social, physical and spiritual aspects…used in an integrated fashion for continual process improvements… Such evaluations will also require a new paradigm of research that uses information systems for rapidly tracking components of total force fitness… Such an integrated paradigm includes contextual understanding of person-specific variables, uses innovative approaches based on rigorous methods of empirical evaluation, and should narrow the gap between science, health care, and training. We cannot sustain our force by staying within the present paradigm.

They’re not alone. Other experts are also calling for ubiquitous, personalized and integrative preventive health that places the patient at the center of care and accounts for a whole spectrum of physical, emotional, social, nutritional, psychological, spiritual and environmental factors. At the heart of this integrated, primary preventive health model is a requirement to achieve sustainable behavior change across large-scale, heterogeneous populations at a cost that is affordable to payers, a "holy grail" that has yet to be achieved.

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