Boards Must Help Fix a FLAWED HEALTH CARE SYSTEM: It is not sufficient to assume that management will handle decisions on employee wellness.

• Author: Hayes, Bill
• Position: BIG IDEAS FOR CORPORATE GOVERNANCE

In his new book, How COVID Crashed the System: A Guide to Fixing American Health Care, Jefferson College of Population Health founding dean emeritus David Nash, M.D., (with coauthor Charles Wohlforth) examines how America's response to the COVID pandemic underlined failures of leadership, racial inequities and more, while noting that the missteps open opportunities to transform a flawed system.

Nash serves on the board of one public company, ANI Pharma (ANIP:NASDAQ), and three privately held firms (InfoMC in Conshohocken, Pa., Max Health in Tampa, Fla. and FOX Rehab in Cherry Hill, N.J.). He is also a board member in the not-for-profit sector, including the Foundation of the American Medical Group Association (AMGA) and the Commission on Accreditation for Healthcare Management Education (CAHME).

In a wide-ranging interview, Nash dives into the board's role in ensuring a health care system that monitors the bottom line but also prioritizes employees' health, a factor that directly affects both business success and the national economy.

Bill Hayes: Can you explain the social determinants of health?

David Nash: The term "social determinants of health" has only been in the vocabulary for the past three to five years. Research clearly shows over decades that the actual delivery of health care services accounts for 10-to-15% of somebody's health, whereas all the social determinants --where you live, how much money you make, your education, whether you are in a food desert, whether you are in a high-crime area--determine way more about your health. Within those social determinants, it's also not just poverty and education, but your own behavior, such as obesity, alcoholism and opioid abuse.

BH: In the case of COVID, how did a system designed to protect citizens against the pandemic crash, and what were the factors that caused the failure?

DN: It's a long list, but I would say the total lack of a public health infrastructure is number one. In 2019, the U.S. spent $10,000 per person, including children, on health care services and $400 per person on the public health infrastructure. So, contact tracing, local health department communication, keeping track of who got vaccinated: We weren't able to do any of that because there was such a starved public health infrastructure, which had been going on for at least a decade. All the experts knew that a pandemic would crush the public health system. Clearly, that aspect of the system failed.

The second...