By Chris Adams

Health care is more than what goes on in the doctor’s office.

That was the message of Dr. Bechara Choucair, a top official at health system Kaiser Permanente, who detailed for National Press Foundation fellows all the ways that what goes on outside the medical establishment impacts what goes on inside a person’s body.

Indeed, Choucair (bio, Twitter) said that 40 percent of health is driven by social and economic factors such as poverty, safety and education; 30 percent stems from health behaviors such as smoking; 20 percent comes from the clinical care in doctors' offices; and 10 percent is due to air and water quality, housing and transit.

“What impacts health? It’s very easy to say it’s the clinical care,” said Choucair, who was trained and practiced as a physician. “But the majority of what impacts health is what happens out in the community – where people work and learn and play.”

Choucair talked about why focusing on public health issues is important to a health system such as Kaiser, which he noted does better when its members are healthier. He also talked about his time as a big city public health commissioner. Before moving to Kaiser, Choucair was commissioner of the Chicago Department of Public Health, where he focused on issues such as teen pregnancy, smoking, drug abuse and gun violence.

Choucair also talked about the definitions of “community health” and “public health.” The are somewhat interchangeable, although public health is more aligned with what government does whereas community health is focused on specific locations.