By DAVID R. WILLIAMS

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

http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-to-the-Annual-Conference-of-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.  

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

http://www.epa.gov/opei/ocmp/dced-partnership.html  

“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.”

3. 
   Surgeon General Issues a Call to Action to Promote Healthy Homes

http://www.surgeongeneral.gov/topics/healthyhomes/index.html 

“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. 
 

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

http://healthreform.gov/reports/healthdisparities/index.html  

“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.  

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

http://www.whitehouse.gov/assets/documents/CEA_Health_Care_Report.pdf

“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. 
 

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

http://www.nytimes.com/2009/06/08/opinion/08levy.html 

“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   

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

http://www.politico.com/news/stories/0609/23559.html#ixzz0I8ZJ27Tl&C  

“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
lives.”  

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

http://views.washingtonpost.com/healthcarerx/panelists/2009/06/priorities-glover-blackwell.html  

“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.