The US health-care delivery system is in the midst of a transformation. For generations, it was rooted in a transactional, fee-for-service ethos that rewarded mainly interventions to treat individuals for diseases. Today, it aims to emphasize improvement in and maintenance of the health of both individuals and communities. The transformation presents the country with the opportunity to reconsider the role of patients and their families in health. Calls to “empower” patients—to change the traditional hierarchic relationships of health care—are not new but are now far more widespread. As in other industries, the availability of information and knowledge resources over the Internet has enabled people to take a more active role in managing their health and their health care and to make decisions that previously required highly trained professionals—in short, has enabled the democratization of health care. Embracing that change not only will improve health outcomes but will address some of the underpinnings of the continued rise in health-care costs and the maldistribution of professional resources.
How can health care be democratized? First, people must have a powerful voice and role in the decisions and systems that affect their health, and they need tools that help them to become far more actively engaged. Second, health professionals and institutions must value social equity and the individual in the context of community. With those principles, we can move from patient-centered health care—focused on sickness, medical interventions, and data on the average patient—to person-centered health care—motivated by wellness, supportive social conditions, and knowledge about the individual and his or her environments.
Those notions underlie the vision of a culture of health—a society in which all people have opportunities for better health where they live, work, learn, and play. Health is powerfully determined by our environments and our social circumstances—our income, education, housing, transportation, neighborhoods, and social and familial networks. As an example of how social determinants affect health, consider the holistic approach to health taken by Philadelphia’s Stephen and Sandra Sheller 11th Street Family Health Services.