Healthcare is like the drunk who lost his keys.

The healthcare industry suffers from the “streetlight effect.” The term stems from an old joke about a drunk looking for his keys. “A policeman sees a drunk man searching for something under a streetlight and asks what the drunk has lost. He says he lost his keys and they both look under the streetlight together. After a few minutes, the policeman asks if he is sure he lost them here, and the drunk replies, no, that he lost them in the park. The policeman asks why he is searching here, and the drunk replies, “this is where the light is.”

In healthcare, we tend to seek solutions where it’s easy rather than where it’s hard. We know that most of what impacts our health occurs beyond the walls of hospitals. According to the American Hospital Association, this includes “societal and environmental conditions such as food, housing, transportation, education, violence, social support, health behaviors and employment.” Health Affairs has an excellent series of articles that show a “path from systemic racism to poor health.”

We also pursue solutions that we’ve already tried and show limited impact. Listening to a recent podcast with Dr. Sachin Jain he noted that “we live in this horrible game of incrementalism coupled with watching really bad sequels play out over and over again.” He explained that we don’t learn from lessons of the past and there is a failure within the industry to “say out loud this has been done before.” Why are we so willing to be drawn to the shiny object that promises to improve quality and access while still reducing cost? We are investing billions in digital health solutions even though so many of them are “over-hyped rehashed sequels that aren’t really moving the needle.” 

Healthcare is like the drunk who is looking under a streetlight for his key that was lost in the dark. Healthcare knows what’s causing most of our health outcomes. Even when we understand the problem, we look where we know it’s easy to create solutions that look good rather than work in the dark and attack hard problems.

I’m sympathetic to the argument that we don’t want to “over-medicalize” issues that are broader societal issues. Healthcare has enough problems; do we really want the industry to take on all these other issues. And solving these complex issues like housing, violence, and racism among others feels like a Sisyphean task. However, there is no denying that a primary cause of homelessness is related to mental health and addiction – both healthcare issues. We know that a diabetic who lives in a food desert will need added support to stay healthy. 

The first step to solving any problem is admitting you have one. Can we agree that we all suffer from the streetlight effect and we’re avoiding hard things? Solving for health equity requires a systemwide approach and as Sachin says, it’s time to “stop thinking small.” To do so, we must be willing to stumble in the dark.