By Sarah Arnquist

If the goal of health reform is to improve Americans' health, then the debate needs to broaden to focus on issues outside the medical system that often play a greater role in determining health.

That’s the message Susan Dentzer, editor-in-chief of the health policy journal Health Affairs, gave to an audience Monday at the Johns Hopkins Bloomberg School of Public Health.

Dentzer began her talk by quoting New York Times Columnist David Brooks, who wrote in a column last fall about a “tide of research in many fields, all underlining one old truth — that we are intensely social creatures, deeply interconnected with one another and the idea of the lone individual rationally and willfully steering his own life course is often an illusion.”

Her point was that communities and social networks play a huge role in
setting social norms and determining health status of the population. And Improving population health should be the goal of any national health
reform effort, she said, and accomplishing that requires a focus on determinants
of health outside the medical care system, such as smoking, obesity,
poverty and social networks.

Given that health status is largely shaped by factors outside the medical system, Dentzer provided some ideas about how a broad-based reform effort might tackle the social determinants of health.

A successful reform effort should be grounded in the acknowledgment that there are direct links between population health and long-term health spending, especially under Medicare and Medicaid, she said. The most vulnerable populations at highest risk for highest costs are also the most likely to end up on Medicaid and subsequently Medicare. “Even if you’re a hard, cynical member of Congress and you don’t’ care about poor people, you better care about them because they’re going to cost you a lot in Medicaid,” she said.

Dentzer's next point was that universal coverage is only starting point. The system must move away from an emphasis on the medical model or must transform the medical model and incorporate a greater role for public health.

Finally, leaders must reconsider issues of economic redistribution in light of its connections to health. She was referring to research that shows income inequality is highly associated with poorer health outcomes.

Yes, that's what she said: Raising taxes on the wealthiest Americans and funneling it back into fulfilling social needs is an essential part of a health reform package focused on health. Dentzer expects this issue to make headlines this week as Obama releases his 2010 budget.