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The Key to Improving Our Health? Look Beyond Health Care.

The United States spent $2.5 trillion on health care in 2009, more per capita than any other nation. Yet our country is ranked 32nd in the world in life expectancy, and rates of conditions such as diabetes and obesity have increased dramatically in recent years.

If we hope to address spiraling medical costs and improve the health of all Americans, we need to begin focusing on the policies — in fields such as transportation, energy, education and agriculture — that shape the world outside the doctor’s office.

But how? Policymakers are already juggling shrinking budgets, crumbling infrastructure and competing priorities. A recently released report from the National Research Council offers a solution. The study, “A Framework and Guidance for Health Impact Assessment,” points out that good health is determined by more than money spent on the health care system. An NRC committee on health impact assessments, of which I am a member, took an in-depth look at why they are needed.

Similar to the way a Congressional Budget Office score predicts the fiscal impact of a proposed policy, an HIA identifies the likely effect on health of a decision in another field, such as building a major roadway, revitalizing a neighborhood or developing energy or agricultural policy. HIAs can help decision-makers identify unintended risks, reduce unnecessary costs and leverage opportunities to improve the health of their communities.

As a doctor, I’ve often cared for diabetics who struggle to follow exercise recommendations because there’s nowhere nearby that’s safe to exercise. I’ve seen patients with frequent asthma attacks exacerbated by living in housing with mold and poor ventilation. I’ve given diet advice to parents of overweight children, only to find that they live in a neighborhood with no grocery store for miles and eat school lunches that should but often don’t meet current nutrition guidance.Continue reading…

Health Impact Assessment: A Tool That Can Build A Healthier America

In December, the Department of Health and Human Services released “Healthy People 2020” — a 10-year blueprint aimed at improving the health of the nation. The plan comes amidst rising rates of many diseases – such as asthma and diabetes — and skyrocketing health care costs.

Now at the dawn of 2011, federal, state and local officials are faced with the tough job of turning the public health goals outlined by that plan into reality.

However, they will almost certainly fail at that increasingly urgent task unless they start factoring health into proposals being considered in non-health sectors like energy, housing, agriculture and transportation.

What does a decision to build a new highway have to do with health?

Plenty, as it turns out.

Depending on how it is planned, a new highway may change levels of air pollutants and the risk of asthma for people living nearby. New traffic patterns may also increase the risk of traffic-related injuries. Furthermore, the roadway might unintentionally cut off an important walking route to and from a transit stop or local school, making it harder for adults and children to get enough exercise.

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