How We Got Here: Chapter 6

how we got here Jun 30, 2026

How Healthcare Lost Health

Estimated read time: 14 min

Last week we looked at how movement quietly disappeared from everyday life. Not exercise, actual movement, the kind that used to just happen as part of being a person. Walking to things, carrying things, using your body as part of a normal day. We traced how industrialization, the car, the desk job, and the screen slowly removed it from daily life without anyone really deciding that was fine. And at the end of that article, a bigger question started forming. If food and movement have such an enormous influence on long-term health, why do they seem to play such a surprisingly small role in the healthcare system?

That's what this week is about.

Most people know the feeling.

You wait weeks for the appointment, sometimes months. You fill out the same forms you filled out last time, sit in the waiting room longer than expected, get called back, have your blood pressure taken by someone who doesn't make eye contact, answer a few questions, and wait again in a smaller room that smells like hand sanitizer. Eventually the doctor comes in. You get fifteen minutes if you're lucky, maybe twenty. You try to explain what's been going on but the conversation has to move fast because there are more patients waiting, more notes to write, more prior authorizations sitting in someone's inbox somewhere.

If something is clearly wrong, that system can be extraordinary. A broken bone. A ruptured appendix. A heart attack. A surgical emergency. In those moments I don't want a podcast recommendation or a breathing exercise. I want trained physicians, imaging, labs, and a surgical team that knows exactly what to do. That's not a small thing. That's one of the most remarkable achievements in human history, and I mean that without any irony.

But most of the health problems people are actually struggling with today don't arrive like emergencies. They build slowly. Weight gain, high blood pressure, insulin resistance, chronic fatigue, poor sleep, anxiety, inflammation, these things rarely appear overnight and they rarely disappear after a single appointment. They're shaped by food, movement, stress, sleep, relationships, and the habits people repeat every single day for years.

Which creates a strange situation. We call it healthcare. But most of the system only gets involved after health has already started falling apart.

Before this goes where you might think it's going, I want to be honest about something.

I think modern medicine is genuinely one of the greatest achievements in human history.

A hundred years ago, infections that are easily treated today were regularly fatal. Surviving a serious accident was far less certain. Premature babies had dramatically fewer chances. Organ transplantation didn't exist. Medical imaging was in its infancy. The conditions we can now diagnose, manage, or cure because of scientific progress represent one of the most extraordinary runs of advancement any field has ever produced. And the people behind it, physicians who complete four years of medical school followed by three to seven years of residency, working long hours under enormous pressure, making difficult decisions every day, deserve a tremendous amount of respect.

This article isn't really about them.

It's about the system they work inside. Because as remarkable as modern medicine has become, the kinds of health problems most people are dealing with today are genuinely different from the ones that system was originally built to solve. And understanding how that gap formed turns out to be a more interesting story than I expected.

The United States spends more on healthcare than any other country in the world. World-class hospitals, cutting-edge technology, remarkable medications, and some of the most highly trained physicians anywhere. If healthcare were simply a matter of scientific advancement, this should be the healthiest population in history.

Instead, heart disease remains the leading cause of death. Rates of obesity, Type 2 diabetes, fatty liver disease, and metabolic dysfunction have climbed steadily for decades. Anxiety, depression, chronic pain, and autoimmune conditions have become genuinely common. According to the CDC, chronic diseases now account for the vast majority of illness, disability, and healthcare spending in the country.

That doesn't mean medicine failed. It means the problem changed.

A century ago, the most serious threats to human life were acute, infections, injuries, and illnesses that appeared suddenly and progressed quickly. Modern medicine became extraordinarily good at solving exactly those kinds of problems. What it wasn't designed for, what nobody really designed it for, were the conditions that develop slowly over decades, shaped by the food people eat, how much they move, how well they sleep, and thousands of small decisions repeated across a lifetime. Those aren't problems that respond to a single prescription or office visit. They require building health long before someone ever needs healthcare.

That distinction is what sent me looking backward. Because if our biggest health problems changed that dramatically over the last hundred years, did healthcare evolve to meet them? Or is it still largely running on a model built for a different era?

To answer that, you have to go back to 1910.

Medicine at the turn of the twentieth century was genuinely chaotic. Scientific physicians, homeopaths, osteopaths, herbalists, eclectic practitioners, hundreds of proprietary medical schools, each operating under different philosophies and wildly different standards. Some schools were excellent. Others offered little more than a diploma to anyone who could pay the tuition. Two doctors practicing in the same town might have received completely different educations.

In 1910, an educator named Abraham Flexner published what would become one of the most consequential reports in the history of American medicine. After visiting more than 150 medical schools across the United States and Canada, he found that most lacked basic scientific rigor. Laboratories were poor or nonexistent. Clinical training was inconsistent. Many graduates simply weren't receiving the education the public assumed they were.

What followed was a massive overhaul. Medical schools closed, merged, or completely restructured. Universities became the standard. Laboratory science moved to the center of medical training. The curriculum became longer, more rigorous, and grounded in anatomy, physiology, pathology, microbiology, pharmacology, and research. Many of the advances we take for granted today, safer surgeries, antibiotics, advanced diagnostics, evidence-based treatment, were built on that foundation.

It was, by almost any measure, an enormous leap forward.

But every educational system teaches people what matters most. And just as importantly, it shapes what matters less. As medicine became increasingly centered on understanding disease through biology, pathology, and intervention, the broader question of how health is created gradually moved to the background. Food, movement, sleep, stress, environment, behavior, these things didn't disappear from the conversation entirely, but they were no longer the primary focus of the institutions training the next generation of physicians. One model had become dominant. Other ways of thinking about health received far less attention.

The consequences of that shift are still shaping healthcare today.

Ideas don't reshape an entire profession on their own. They need institutions, universities, and money.

The Flexner Report changed the direction of medicine, but implementing those changes required enormous financial investment. Universities needed new laboratories. Medical schools needed faculty, equipment, teaching hospitals, and research facilities. That's where organizations like the Carnegie Foundation and John D. Rockefeller's General Education Board entered the story. The Carnegie Foundation commissioned Flexner's investigation. Rockefeller's philanthropy became one of the largest financial supporters of the new model. Through the General Education Board, millions of dollars flowed into universities, teaching hospitals, medical research, and physician training. Schools that embraced the emerging scientific model received funding to expand. Over time, that model became the only model anyone seriously considered.

Medical schools train physicians. Physicians shape clinical practice. Clinical practice shapes what the public comes to expect from medicine. Over generations, the way physicians were educated became the way society came to understand what medicine was for.

Those investments produced extraordinary breakthroughs that continue to save lives. But every investment is also a decision about what won't receive the same level of attention. As universities and medical schools focused increasingly on understanding disease, comparatively less emphasis landed on understanding how health is created in the first place. Nutrition, movement, sleep, stress management, behavior change, and prevention never completely disappeared, but they weren't the primary mission of the institutions shaping the profession. We built one of the most sophisticated disease-treatment systems the world has ever seen. We invested far less in understanding how to help people avoid needing it.

That imbalance was manageable when the biggest health threats were infections and injuries. It becomes a much bigger problem once the dominant health challenges are conditions that develop over decades.

This history helped me understand something I'd wondered about for years working as a health coach.

Why do so many people leave the doctor's office knowing what's wrong, but still not knowing how to get healthier?

Physicians are trained to diagnose disease, interpret laboratory results, recognize pathology, prescribe medications, and manage complex medical conditions. That's an extraordinary body of knowledge that takes years of dedicated work to master. But building health is a genuinely different skill. Helping someone consistently eat better, sleep more, manage stress, change lifelong habits, navigate setbacks, and sustain a healthier lifestyle over months and years isn't something that happens through diagnosis alone. It's coaching. It's education. It's accountability. It's a process that unfolds over time, not over the course of a single appointment.

One thing genuinely surprised me while researching this. The average medical student receives roughly twenty hours of nutrition education across four years of medical school. Many receive less. Compare that to registered dietitians or lifestyle medicine specialists, where hundreds or thousands of hours are devoted specifically to nutrition, counseling, and behavior change.

We've been expecting one profession to do the work of several. We ask physicians to diagnose disease, prescribe medication, interpret blood work, coordinate care, stay current with an enormous and constantly expanding body of research, and somehow also serve as nutrition experts, exercise coaches, behavior-change specialists, and long-term accountability partners. Nobody could realistically master all of that, especially inside an appointment that often runs less than twenty minutes.

Once I understood that, the doctor's office started making a lot more sense. Not because physicians have failed anyone. Because most of us have fundamentally misunderstood what they were trained and given the time to actually do.

Which brings me to the time problem, because it's worse than most people realize.

One study estimated that if a primary care physician attempted to deliver every recommended guideline for preventive care, chronic disease management, acute care, and administrative responsibilities, they would need nearly twenty-seven hours in a single day. That's not an exaggeration meant to make a point. It's just math.

Add everything else on top of that. Reviewing lab results. Returning calls. Completing documentation. Responding to patient messages. Coordinating with specialists. Fighting insurance companies over prior authorizations. Seeing a full schedule of patients. The fifteen or twenty minute appointment isn't the result of anyone not caring. It's the result of a system with far more demands than hours.

I've heard from clients for years that their doctor never talked to them about nutrition, or just told them to lose weight and left it there. The frustration is completely understandable. But think about what it would actually take to help someone lose fifty pounds in a lasting way. You'd need to understand their schedule, their family situation, their budget, their cooking habits, their relationship with food, their stress levels, their sleep, their exercise history, their past attempts, and what got in the way before, and then help them build something they can realistically maintain for months or years. That's not a fifteen-minute conversation. That's an ongoing relationship.

Modern healthcare is structured to diagnose and manage disease efficiently. It was never really structured to coach people through the slow, difficult, deeply personal work of changing how they live. Once I saw that clearly, I stopped wondering why doctors weren't doing more lifestyle coaching and started wondering why anyone ever expected them to.

There's one more piece of this that I think gets overlooked.

We've become remarkably good at keeping people alive. People survive illnesses, injuries, and surgeries today that would have been fatal a generation ago. By almost any historical measure, that's one of the most significant things medicine has ever accomplished.

But living longer isn't automatically the same as living well.

Most people aren't dreaming about simply adding years to their life. They want to travel, pick up their grandchildren, work in a garden, go hiking, stay sharp, get up off the floor without help, dance at someone's wedding without their knees giving out. That's the difference between lifespan and healthspan, the years we remain genuinely healthy, capable, and able to fully participate in our own lives. And healthspan isn't primarily built in hospitals. It's built years, often decades, before someone ever needs one.

Health isn't just the absence of disease. It's the capacity to fully show up for your life. The strength to carry your groceries without thinking about it. The energy to keep up with your kids. The resilience to recover from setbacks without falling apart. Disease affects health, but health has always been much bigger than disease alone. Somewhere in the last century, we became so focused on extending life that we stopped asking how well those extra years were actually being lived.

Researching this article changed how I think about my own career.

For years when someone asked what I do, I'd say I help people get healthier. That's still true, but it feels incomplete now. I don't think I've spent the last twenty years competing with healthcare. I think I've spent twenty years teaching people how to participate in their own health again.

When I first meet with a client, the conversation almost never starts with disease. It starts with life. What they eat on a normal Tuesday. Whether they know how to cook. How much they move outside of exercise. How well they sleep. What their workdays look like. How stressed they are. Those questions aren't designed to diagnose anything, but they often explain exactly how someone ended up struggling with their health in the first place.

Over the years I've had countless clients come in frustrated after leaving a doctor's appointment. They weren't angry at their physician, most of them actually liked their doctor. They were frustrated because they wanted someone to help them connect the dots. What to eat. How to grocery shop. How to exercise without getting hurt. Why they were always tired. How to finally lose the weight they'd been carrying for years. They weren't looking for another diagnosis. They were looking for a roadmap. For a long time I couldn't understand why those conversations seemed so hard to find inside the healthcare system. After going through all of this research, I think I finally do.

Those conversations require a completely different environment. They unfold over months and years through education, trial and error, accountability, and small adjustments that gradually become habits. They were never designed to fit inside a fifteen-minute office visit, and expecting them to is like being frustrated that a mechanic won't teach you to drive.

I stopped expecting doctors to build health for people once I understood that was never really the job they were trained to do. Modern medicine is there when something has gone wrong. The work I've spent my career on happens much earlier, helping people develop the habits, strength, and resilience that improve the odds they stay healthy longer, so that if life eventually sends them to the healthcare system, they arrive in better shape than they otherwise would have.

Health isn't something handed to us by a doctor, a coach, or a prescription. Those people can educate, guide, and help when we need them. But they can't live our lives for us. They can't cook our meals, take our walks, prioritize our sleep, or make the thousands of ordinary decisions that quietly shape our future.

Those decisions still belong to us.

If there's one thing worth taking from this, it isn't that we should trust doctors less. It's that we should stop expecting the healthcare system to create our health for us.

For more than a century, we've invested extraordinary time, money, and scientific effort into building one of the most advanced medical systems the world has ever seen. Those investments have saved countless lives. But somewhere along the way, many people began treating healthcare and health as the same thing.

They aren't.

Healthcare is what we turn to when something has gone wrong. Health is what we're building long before that moment ever arrives. It's built in kitchens and on walks and in grocery stores and in the small decisions made every day that most people never think of as health behaviors. None of those choices guarantee we'll never get sick. They just stack the odds in our favor and give us a better foundation to recover from whatever eventually comes.

We need physicians who can save our lives when things go seriously wrong. We also need a culture that remembers health was never something we were meant to outsource in the first place.

One question kept pulling at me the whole time I was writing this.

If prevention genuinely improves health, reduces suffering, and costs far less than treating chronic disease after it develops, why does so much of our healthcare economy still revolve around managing chronic illness instead of preventing it?

That's where we're headed next. Because once I started asking that question, I wasn't just following the science anymore.

I was following the money.

I'm Coach Andy, founder of Protean Fitness. If this series is resonating with you, follow along on Instagram and LinkedIn, or join the Protean Wellness Community.

How We Got Here: Chapter 6

How Healthcare Lost Health

Sources

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