Eight Signs that Wellness and Prevention have become Health Reform Priorities

Health care reform alone won’t make
America healthier. We’ve seen this basic message as recently as yesterday,
in Ezra Klein’s piece for the American Prospect, “Wealth-Care Reform.”  At the Robert
Wood Johnson Foundation Commission to Build a Healthier America
, we’ve been studying prevention, wellness,
and the broader factors that influence good health for nearly two years. 
And as the health care reform debate has heated up over the last few
weeks, we’ve seen eight signs that health reformers and leaders from
all sectors are starting to get the message that there’s more to health
than health care. 

  1. President Obama’s Speech
    to the American Medical Association


    “The second step that we can all
    agree on is to invest more in preventive care so that we can avoid illness
    and disease in the first place.  

    “Our federal government also has
    to step up its efforts to advance the cause of healthy living. Five
    of the costliest illnesses and conditions – cancer, cardiovascular
    disease, diabetes, lung disease, and strokes – can be prevented. And
    yet only a fraction of every health care dollar goes to prevention or
    public health.  That is starting to change with an investment we
    are making in prevention and wellness programs that can help us avoid
    diseases that harm our health and the health of our economy.” –
    President Barack Obama, Speech to the American Medical Association on
    June 15, 2009 

In the longest speech of his presidential
career and at a critical time in the health reform debate, President
Obama made his case for change and a renewed focus on prevention and
public health.  He discussed how each of us can take personal responsibility
for our health, how school lunch programs can incorporate healthier
foods to fight obesity, how employers can invest in wellness to both
improve health and reduce health care costs, and how government can
make healthy living a priority – all key to improving health and important
components of the Commission’s recommendations http://www.commissiononhealth.org/Recommendations.aspx.  

  1. DOT, HUD and EPA Form Collaboration
    to Create Healthier, More Livable Cities


    “Creating livable communities will result in improved quality of life
    for all Americans and create a more efficient and more accessible transportation
    network that services the needs of individual communities.  Fostering
    the concept of livability in transportation projects and programs will
    help America’s neighborhoods become safer, healthier and more vibrant.”
    – Department of Transportation (DOT) Secretary Ray LaHood, Partnership
    for Sustainable Communities 

A new interagency partnership released
this week coordinates federal transportation, environmental protection
and housing investments towards more livable communities.  It’s
a great step that will connect the priorities and investment dollars
of these three agencies around principles like affordable housing and
“healthy, safe and walkable neighborhoods – rural, urban or suburban.”

  1. Surgeon General Issues a Call to Action to Promote Healthy Homes


    “Houses are the places where parents
    raise their children, where family reunions take place, and where people
    live, work, and play. Americans have always realized that healthy houses
    can lead to healthier lives.” –
    Secretary of Health and Human Services (HHS)
    Katherine Sebelius, “Surgeon General’s Call to Action to Promote
    Healthy Homes” 

Last week, the Surgeon General called
for action to improve unhealthy and unsafe housing in America (you can
read my earlier blog post on this here).  The report, introduced by Sebelius’
message above, recognizes the effects of poor-quality housing on “millions
of people of all income levels, geographic areas, and walks of life
in the United States.”  Importantly, the Surgeon General says
that improving homes will take a commitment from government and
individuals – a dual responsibility that will be critical to building
healthier homes and communities and improving this country’s health. 

  1. White House Disparities
    Conference and New Report Highlight Need for Reform


    “The disparities in health care
    highlighted in this report (read it here http://healthreform.gov/reports/healthdisparities/index.html) demonstrate the need for reform. Meaningful
    reform must invest in prevention and wellness and ensure that all Americans
    have access to high-quality, affordable care. We can no longer afford
    to tolerate disparities in health.” – Statement from
    “Health Disparities: A Case for Closing the Gap” at healthreform.gov 

I had the privilege of joining a group
of experts at the White House last week to talk about the Commission
and the need for prevention and wellness – and I’m encouraged by
what I saw.  From the heads I saw nodding in approval to an understanding
in the new report from the White House and HHS that any reform must
include investment in prevention, there’s momentum around changing
the way we think about health.  

  1. President’s Council of
    Economic Advisers’ Report on Health Care Cites Commission Research
    Showing Importance of Social Factors on Health


    “Of course, many factors other
    than health care expenditures may affect life expectancy and infant
    mortality rates, including demographics, lifestyle behaviors, income
    inequality, non-health disparities, and measurement differences across
    countries.” – President’s Council of Economic Advisers,
    “The Economic Case for Health Care Reform” 

In a report given to President Obama
last week, the Council of Economic Advisers points out that health in
America has a lot to do with factors beyond health care expenditures. 
Citing the Commission’s Obstacles to Health,
the Council says factors like income, demographics and lifestyle play
a major role in life expectancy and infant mortality rates in the U.S. 

  1. The New York Times
    Op-Ed Discusses the Health Benefits of More Education


    “The benefits of an extra year
    of schooling are beyond question: high school graduates can earn more
    than dropouts, have better health, more stable lives and a longer life
    expectancy. College graduates do even better. Just as we are moving
    toward a longer school day (where is it written that learning should
    end at 3 p.m.?) and a longer school year (does anyone really believe
    pupils need a three-month summer vacation?), so we should move to a
    longer school career.” 

An op-ed last Monday in the New York
Times echoes what the Commission has shown with its two state-by-state
chartbooks: more education means better health for adults and, in turn,
for their children.  You can see how mortality rates would change
in your community if education levels were different using the Commission’s
Education and Health Calculator.  http://www.commissiononhealth.org/calculator   

  1. Politico’s Take on Health
    Care Says Reform will Include Nutrition, Wellness
    and a Focus on Building Healthier Communities


    “Any health care reform plan that
    Obama signs is almost certain to call for nutrition counseling, obesity
    screenings and wellness programs at workplaces and community centers.
    He wants more time in the school day for physical fitness, more nutritious
    school lunches and more bike paths, walking paths and grocery stores
    in underserved areas.” – Politico, June 10, 2009 

Politico’s recent coverage of the health
care reform debate focuses on the new role of government in making America
healthier.  From President Obama’s picks for top health jobs
to Congress’ recent consideration of a tax on sugary drinks, the conversation
in Washington is changing to include health promotion and disease prevention. 

“This isn’t about telling people
what to do,” added a spokesman for Kathleen Sebelius. “It is about
giving people the tools they need to live longer, healthier, happier

  1. Washingtonpost.com
    Features Angela Glover Blackwell: Congress
    Must Start Thinking Beyond Health Care


    “Congress must start thinking about
    health beyond health care. The pending legislation offers a real opportunity
    at revitalizing the health of millions of Americans — not just tweaking
    an outdated and under-performing health-care industry.” – Angela
    Glover Blackwell, washingtonpost.com  

Angela Glover Blackwell, a Commissioner
who has joined us on our journey across the country looking for ways
to improve the health of all Americans, states the case for looking
beyond health care in a commentary for The Washington Post.   

There’s a consensus growing in Washington
and across America: There is more to health than health care. 
To truly address health in this country, we need to look beyond medical
care – which accounts for only 10-20 percent of preventable deaths
– and focus on the factors that keep us from getting sick in the first
place.  From the past two weeks alone, it is clear that momentum
to change the conversation around health is building.  I look forward
to your comments and discussion below.

Dr. Williams is the Staff Director of the Robert Wood Johnson
Foundation Commission to Build a Healthier America.  He is also
the Norman Professor of Public Health at the Harvard School of Public
Health and a Professor of African and African American Studies and of
Sociology at Harvard University.

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9 replies »

  1. jd,
    The items in your last paragraph have statutes addressing them. Being obese has no statute, but it will if it becomes the government’s burden. Now we have FDA regulating tobacco, like that is going to change smoking one iota. Big whoop.
    The purpose of the country was to deter overbearing government from meddling in the lives of its citizens. Whatever cause you feel justifies piercing the veil of freedom, it is not justifiable in any case.
    No matter how much “healthcare” we inflict on the nation, we still all die. The question is not how we die, but how we live. Why be healthy just to feed the master? Does not one original state declare “Live free or die.”?
    Who is President Borg Obama to tell you how to live?

  2. Dear Dr. Williams,
    I strongly agree that “there is more to health than health care” and one of those pieces of the bigger picture is free choice. My view is that individuals are the key to their own wellness, and more types of insurance emphasize more insurance industry and political control, not less. Without individual free choice on our own health matters, we are detaching ourselves from one of the major links to good health in the first place — free choice.
    A book I have recently written highlights this viewpoint and I want to draw it to your attention, as you may be interested in it. The title is “Soul Talk With Cells: What We Really Want Is To Play” and information is available at http://www.strategicbookpublishing.com/soultalkwithcells.html If you have any questions, I am most willing to offer my views on this topic.
    Flora Sue Gardner

  3. MD as HELL: prevention (in the sense of wellness or lifestyle change) is “healthcare” if we want it to be. It’s a matter of how a word is defined on the one hand, and on the other hand what we pay doctors to do. There is no reason why a physician shouldn’t be compensated in part on the basis of whether they help their patients not to get sick in the first place. No one wants physicians to be nannies, coaches or personal trainers, but I don’t expect that will quell your angry fear.
    People want physicians to pay attention to public health goals and and the non- “medical” component of health. We get that you didn’t go to medical school just to do what an MPH or a health coach does. It’s more about giving greater attention to the importance of non-medical interventions (often as effective as medical interventions), and about following up on patients, and yes, occasionally telling/reminding them that they are killing themselves by smoking/eating junk food, etc. and having information available on more and less effective ways to stop doing whatever they’re doing. It’s not that complicated.
    While it’s true that physicians aren’t necessary to get people to understand the value of prevention, the fact remains that due to perceived authority people often respond better to what their physicians tell them than to what the television tells them, or their mayor in some rah-rah health campaign, or even their spouse.
    Design the payment system to produce the goals you want. The focus should be on the levers that work.
    And why treat gluttony and sloth as matters of personal freedom rather than moral failings that deserve to be addressed at multiple levels of society, though they are not forbidden by law? Why shouldn’t a politician speak against them? Why shouldn’t a doctor? Yet, you say those choices are to be respected without “meddling in the private lives of Americans in a free country who wish to pursue happiness unfettered by your vision.” Is it really a “personal vision,” or is it closer to a universal moral truth that gluttony and sloth are destructive to a nation? Your use of the language “wish to pursue happiness” makes it sound like you think most obese people are happy they are obese, instead of frustrated by their inability to stop getting fatter.
    As for not legislating morality, do you feel the same about gay marriage, or prostitution, or doing drugs? How about other sins like adultery or murder? No government involvement in any of these?

  4. I agree that it doesn’t take a doctor to tell someone to lose weight. However, issues like obesity must still be addressed. To keep costs in check, I think the message must be delivered by public health agencies and, from a healthcare standpoint, nurse practitioners and dieticians. Physicians are not a cost effective means for delivering anything related to prevention and wellness.
    Your last point is a very important one. People feel they have a right to eat what they want and live how they want. That is true, but unfortunately that is often a dangerous way of living. Obama should have allocated at least 5 times the amount to prevention and wellness that he did. Sooner or later, the medical community or someone else, needs to illustrate the connection between unhealthy lifestyles at 40 and the chronic illnesses that will result at 65.

  5. Deron,
    My vision is fine. It does not take a doctor to tell people to lose weight, stop smoking, wear seatbelts, don’t abuse alsohol, get exercise, pay attention to your family medical history and get proper screening.
    If you are saying it takes care managets to keep people healthy then you are meddling in the private lives of Americans in a free country who wish to pursue happiness unfettered by your vision.

  6. I’m actually disappointed at the ratio of ARRA funding for prevention/wellness to the funding for HIT. I think the figures should be reversed because chronic illness is the top cost driver, with no close second. It is imperative that we reverse the trend.
    MD as HELL – Your comment saddens me. It reflects the short-term, “treat the sick” mentality of our current system and it desperately lacks vision.

  7. Wellness and prevention are not medical issues. They are “pre-healthcare” events. Don’t even think about promoting “reform” for these goals. They are good public policy goals, but not healthcare issues.

  8. Not having read the Senate HELP and Finance or the major House reform bills, I would be particularly interested to know what about prevention and wellness is in those bills. That will give us more of a sense whether all the talk is translating into action.
    Collaboration between HUD, EPA and DOT is very encouraging. Walkable (and walked) neighborhoods are more important for health than people realize. Zoning laws are a huge problem here, as Atrios keeps pointing out.
    Now, what about food? Removing subsidies for corn should be particularly high on the agenda. Taxes on refined sugar might be a good idea. Obviously, there is a ton that we need to do here.