OP-ED

Separating Fact from Fiction and Health from Health Care

By JAMES S. MARKS, ROBERT WOOD JOHNSON FOUNDATION

James S. Marks In an editorial on Wednesday, The New York Times debunks the often-cited claim that America has the best health care system in the world.  For the politicians who routinely use this as a plank in their efforts to stifle reform, the Urban Institute study (disclosure: this study was funded by the Robert Wood Johnson Foundation) is an objective rebuke. The U.S. health care system is not the best – far from it.  And Americans, with a life expectancy that still trails many other countries, are not the healthiest people in the world.

Clearly, this country desperately needs health reform.  But the study, the editorial, and the entire current discourse around health care neglect an important truth about reform: fixing the health care system alone will not significantly improve Americans’ health.

For example: medical spending consumes 16 percent of the U.S. GDP and is projected to reach a staggering one dollar for every five earned by 2018.  And yet, only 10-15 percent of preventable mortality is linked to health care.  This and our terribly poor international rankings in length of life are telling signs that our tremendous investment does not do enough to address the factors that make us sick in the first place.

Our current national debate must look beyond health care – the so-called repair shop of our health system – and focus on our health.  Fixing health care will require insurance reform, cost containment and sound economic policy.  Fixing health will require us to look at our neighborhoods, our schools and our workplaces.  From our earliest years of life, these are the places that determine how long and how well we live in America.  The recommendations of the Robert Wood Johnson Foundation Commission to Build a Healthier America, which identify pockets of success where programs are making a real difference in people’s health, provide a useful place to start.

In schools, where obesity threatens the current generation of children with sicker and shorter lives than those of their parents, solutions are critically needed.  By guaranteeing daily physical activity in schools – which fewer than 3.8 percent of elementary schools provide – and linking federal funds for school meals to their nutritional value, we can reverse the epidemic and help our children grow up healthy.

In our neighborhoods and communities, we must consider the health impact of investments and development to ensure that they help promote physical activity, make healthy foods more readily available and lay a foundation for prosperity.  With public-private partnerships, we can bring grocery stores and nutritious food into underserved neighborhoods and help both the stores and the neighborhoods thrive.  By incorporating bike lanes, sidewalks and trails into our transportation planning, we can help make the daily lives of Americans more physically active.

All of this amounts to a change in the way we think about health in this country.  Health care reform, while critically important, will not avert the crisis of poor health that we’re facing.  The Times editorial and Urban Institute study shine an important light on the dubious claim that we have the best health care system in the world, but they don’t go far enough.  It’s time that we debunk the larger myth, that Americans are the healthiest people in the world, so all of us – from the halls of Congress to the family dinner table – can start working to improve the health of the country we love.

Dr. James S. Marks, M.D., M.P.H., senior vice president at the Robert Wood Johnson Foundation and director of the Foundation’s Health Group.  Dr. Marks oversees all of the Foundation’s work in childhood obesity, public health and vulnerable populations.  Prior to RWJF, Dr. Marks was an assistant surgeon general and director of CDC’s National Center for Chronic Disease Prevention and Health Promotion.

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P90XBMAmanda S.James MarksJan Henderson Recent comment authors
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P90X
Guest

Hi People,
This is a great article, From last many years we have taken our knowledge to great height and still lots of fiction exists. We need to differentiate it from fiction. Well see what happens. Do keep us update.

BM
Guest

MiniCare is a 501C3 designated as a public charity by the IRS. Its mission is simple; provide low cost primary care to millions of Americans who cannot afford to see a doctor. Each Member pays a $5.00 annual membership fee and $22.00 per office visit. MiniCare does not require or accept any form of insurance. Small businesses can subscribe to MiniCare’s “Corporate Plan” whereby. employers are charged an annual fee along with a deposit based on the number of MiniCare ID cards issued. Gold Plan Members are entitled to unlimited office visits at one fixed moOPENING SOON Meadows Mall Clinic… Read more »

Amanda S.
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Amanda S.

This is a great post. When you say, “… fixing the health care system alone will not significantly improve Americans’ health,” you make an excellent point. There are still plenty of issues that need to be addressed like Americans not taking proper care of themselves despite having health care. You’re right when you say how health care and health can be two entirely different things. Though we do need a reform on health care, it isn’t going to help problems like childhood obesity or even obesity into adulthood. More physical activity must be done, and one must eat better foods… Read more »

James Marks
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James Marks

Thanks for the comment Tamika and others who commented on hers. Your points are well made and amplify what I was trying to say. Most people when they think of causes of good or ill health think of biologic mechanisms. But equally fundamental causes of health or illness are how our communities are built, what our policies or laws encourage/permit or inhibit in housing or transportation or schools. But people do get it when it is framed as the the toxins or microbes one is exposed to in their neighborhood, the safety of the community or worksite, whether one smokes… Read more »

James Marks
Guest
James Marks

Thanks for the comment, Meg You are right that I should have included that the report was one that we supported and it has been added it to the post. For those who would like to see the whole report, it is on our website. http://www.healthreform.org This site has lots of other reports and materials on the issues and debates.

Jan Henderson
Guest

Tamika, that’s so important. I read a great article last summer on relative deprivation called “Unequal America” (http://harvardmagazine.com/2008/07/unequal-america.html). “If people are worried about their basic needs of survival and security and food and shelter, they cannot worry about the fact that a cigarette is going to cause lung cancer 20 years from now.”
I’m still haunted by this statistic: “American respondents were much more likely than European respondents (71 percent versus 40 percent) to agree with the statement that the poor could escape poverty if they worked hard enough.”

Deron S.
Guest

Well said Tamika. The problems we call healthcare problems are actually deeper societal problems that have spilled over into healthcare. Greed, selfishness, impatience, and myopic thinking can be found throughout society, and I think at least a little bit of them are in all of us. Government has increasingly become an entity which protects us from ourselves. At what point to do we stop with the workarounds (bundled payments, public option, etc.) and address the problems directly. Anyone that thinks we can “fix” the healthcare and financial sectors and life will be sweet is naive. If it takes legislation or… Read more »

Jan Henderson
Guest

There’s an interesting commentary in the August 12 JAMA on addressing health problems through “structural interventions” (http://jama.ama-assn.org/cgi/content/extract/302/6/683 – subscription required). Telling people to change their diet and to exercise more hasn’t been very successful. If the environment contributes to poor health – lack of fresh fruits and vegetables and safe places to play in poor neighborhoods, pollution, pesticides – why not change the environment to make it healthier? More physical activity in schools, as James mentions, also promoting urban design that allows walking to schools and stores, bicycle paths, wider sidewalks, menu labeling in restaurants, school salad bars. Even things… Read more »

Tamika Bolden
Guest
Tamika Bolden

There are many valid points within this blog. There should be a separation between health and healthcare. In order to have healthier individuals other factors must be considered for this perspective to be successful such as a change in economic distress and the deviant social behaviors of the American people. For example, the introduction of affordable healthier grocery stores, bike lanes and etc. are wonderful suggestions but the reality of them being beneficial in the communities that are in are in jeopardy is questionable. Survival is what people are facing at this time. How can we handle child hood obesity,… Read more »

Meg
Guest
Meg

Shame on you for not disclosing that the Robert Wood Johnson Foundation funded the “objective rebuke” this blog is based on. If it’s so objective, what are you hiding?

Robert Forster
Guest
Robert Forster

Thank you Dr. Marks for making the distinction between population health and health care. I believe Tim reinforces the semantic trap we are currently in regarding reform. Many have said that Population health (which explains the counter intuitive facts that Americans have the most costly “system” and yet mediocre overall health)is derived 50% from culture (personal behavior)+ 40% gestational and genetic endowments + only 10% from the “health care delivery system.” I believe using the term healtcare delivery avoids the semantic fog exhibited by Tim. Yes, we could have the perfect healthcare delivery system for the ill yet have poor… Read more »

Peter Nesbitt
Guest

I second the positive comments to this post. It’s a good starting point for health care reform.

Deron S.
Guest

Mr. Marks – Excellent post! It’s refreshing to hear a non-partisan, pragmatic view for a change. I’m working on a community-wide initiative to address the obesity epidemic in my local area. The goal is to address all of the societal/environmental factors contributing to unhealthy lifestyles, in addition to the individual factors. I’d love to discuss it with you if you’re willing. You can find my e-mail address by linking to my blog.

MD as HELL
Guest
MD as HELL

Ever hear of evolution? Why fight it?

Clarence Pearson
Guest
Clarence Pearson

James, Great statement. In anticipation of our conference call, please note the following: Letter to the Editor New York Times Instilling Healthy Habits Published: July 19, 2009 To the Editor: Re “A Strong Health Reform Bill” (editorial, July 16): As comprehensive health care reform takes center stage, President Obama and our legislative leaders once again are facing the inevitable challenges of paying for health care. Emphasis on the importance of early childhood health promotion, health education and disease prevention will have an impact on a person’s health over a lifetime, probably more than any short-term medical intervention solutions being proposed.… Read more »