Creating a healthy America doesn’t end with insurance reform

David Williams, Florence Sprague Norman and Laura Smart Norman Professor of Public Health

September 9, 2010 — For the first time in history, many children in the United States may be facing shorter, sicker lives than their parents. While improving access to health care is essential, insurance reform alone will not make America healthier and reduce spiraling costs, according to a new article in the August 2010 issue of Health Affairs. Creating a healthy nation requires a national commitment to reducing everyone’s risk of getting sick in the first place.

The article was co-authored by David Williams, Florence Sprague Norman and Laura Smart Norman Professor of Public Health at Harvard School of Public Health (HSPH).

“We need to pay far greater attention to those factors that have the most profound impact on our health,” said Williams. “These include the homes and communities where we live, the schools where we learn, the food we eat, the air we breathe and the workplaces where we spend so much of our time. These social factors begin influencing our health very early in life.”

The recently passed Patient Protection and Affordable Care Act will allow an estimated 32 million more Americans to gain health insurance coverage over the next 10 years, reducing the proportion of the uninsured to about six percent of the population. However, Williams cautions, more attention needs to be paid to prevention, at all levels of society.

In the article, Williams and co-authors Mark McClellan and Alice Rivlin, both senior fellows at the Brookings Institution, comment on the policy recommendations issued by the Robert Wood Johnson Foundation’s Commission to Build a Healthier America. Williams served as staff director of the commission, which included McClellan and Rivlin, as well as Katherine Baicker, professor of health economics at HSPH. The non-partisan, independent commission conducted a year-long investigation into the many factors outside of medical care that influence health, and developed ten recommendations emphasizing those that support early childhood development and families. These include:

  • Ensure that all children have high-quality early developmental support (child care, education and other services).
  • Feed children only healthy foods in schools.
  • Require all schools (K-12) to include time for all children to be physically active every day.
  • Create public-private partnerships to open and sustain full-service grocery stores in communities without access to healthful foods.
  • Fund and design WIC and SNAP (Food Stamps) programs to meet the needs of hungry families for nutritious food.
  • Integrate safety and wellness into every aspect of community life. Schools, workplaces, neighborhoods and religious institutions can foster safety and health.
  • Create “healthy community” demonstrations to evaluate the effects of a full complement of health- promoting policies and programs.
  • Develop a “health impact” rating for housing and infrastructure projects that reflects the projected effects on community health and provides incentives for projects that earn the rating.
  • Become a smoke-free nation. Eliminating smoking remains one of the most important contributors to living longer healthier lives.
  • Ensure that decision-makers in all sectors have the evidence they need to build health into public and private policies and practices.

The Commission concluded that creating a healthy nation is an attainable goal. Everyone needs to take responsibility for their own health, however, it is not always easy for everyone — particularly members of disadvantaged groups — to choose health. Therefore, Americans must collectively take steps to support healthy choices for all, according to the researchers.

“For policymakers, this will mean breaking out of the silos that they have become so accustomed to working in,” Williams said. “To be effective, they can’t address health as a single, isolated policy domain. Because so many factors affect health, it needs to be considered as a factor in all policymaking, from transportation to housing to education to community planning. Historically these issues have not been viewed as connected to each other.”

The costs of inaction are staggering, not only in terms of health impact but also in economic impact. Obesity has doubled since 1987, which accounts for nearly 30 percent of the increase in health care spending, according to the researchers. And if current trends continue, more than 44 million Americans will have diabetes within 25 years — at an annual health care cost of $336 billion.

However, the researchers write: “We have strong evidence that major strides can be made outside of medical care, and clear opportunities exist to implement, refine, and expand proven strategies. With informed choices on the part of individuals and policymakers, all Americans can have a healthier future.”

— Amy Roeder

photo: Ned Brown