Much of the political debate over health reform has focused on the important questions of affordable health insurance coverage and access to medical care. However, medical care is far from the most important factor influencing health, a fact that is at the core of a newly released report from the Robert Wood Johnson Foundation’s Commission to Build a Healthier America.
The Commission was initially formed in 2008 and issued 2009 recommendations concerning influences on health such as nutrition, physician activity, and tobacco use. The new report, “Time To Act: Investing in the Health of our Children and Communities,” also focuses on socioeconomic factors; specifically, it recommends increased investments in early childhood development, including universal access to quality early childhood development programs for low-income children under age 5; efforts to promote healthier neighborhoods through collaboration among the health, community development, and finance sectors; and a new orientation for health care providers toward nonmedical determinants of health and working with nonmedical professionals. The report provides examples of successful initiatives in each of these areas.
Most people think about health and health care together, said Mark McClellan of the Brookings Institution, who co-chaired the Commission with Brookings colleague Alice Rivlin, in a webcast marking the report’s release. But “when you start looking at the evidence, looking at what’s working on the ground to actually have a meaningful impact on the health of people,” you realize that “you can’t get there just by putting more resources into health care.”
The new report signals a renewed emphasis for RWJF on addressing the broad universe of factors beyond health care that affect health. “Over the next year, our foundation is really going to invest in what we’re talking about as a culture of health — that is, how do we come together across sectors to make America healthier,” said Risa Lavizzo-Mourey, President and CEO of the foundation. This post will briefly touch on the report’s recommendations, with more discussion to follow in the coming days via a guest post on Health Affairs Blog and our sister publication, GrantWatch Blog.
Invest in early childhood education and support programs. The U.S. currently ranks 25th in public investments in early childhood education (among 29 industrialized countries). Disparities in children can start as early as nine months. “What happens in the early childhood period affects your lifelong physical and mental health,” said Jack Shonkoff, director of the Center on the Developing Child at Harvard University, in the webcast. “When children experience toxic stress, it disrupts their brain circuits, their hearts and their cardiovascular system; it affects their metabolic system, so early childhood is important because it is the key to improving lifelong health.” Marla Salmon, nursing and public health professor at the University of Washington, added that cardiac, diabetes, and obesity-related diseases are traceable to early stress experiences of children.
Integrate health, community development, and finance. Nearly one-fifth of Americans live in low-income neighborhoods, with few opportunities for healthy living, the report says: “There is a broad ecosystem of organizations that serve the same ‘customer,’ ‘client,’ or ‘patient’ living in the same neighborhood, but seldom work together to meet that person’s different needs.” To bring these organizations together will require breaking down funding siloes, establishing incentives and performance measures that reward collaboration, and recognizing that investments in one sector can generate savings in another; for example, investments in housing or transportation could reduce health care costs, and a portion of those savings could then be invested back into health-promoting neighborhood development.
Take a much more health-focused approach to health care finance and delivery. In a 2011 national survey conducted for RWJF, 85 percent of physicians reported that their patients’ social needs are as important to address as their medical conditions. The report recommends using new health “vital signs” to assess nonmedical determinants of health. Commission member Kyu Rhee, integrated health services vice president for IBM, explained this with a HEALTH acronym: housing, education, access to healthy choices, labor opportunity, transportation, and a holistic, patient-centered approach.
Rebecca Onie, co-founder and CEO for Health Leads, reported that when patients in Boston were surveyed, 59 percent had at least one unmet resource need. “[This] has a huge impact on health outcomes or health care cost,” she said. “Health Leads often sees patients who are supposed to be refrigerating their diabetes medications, but don’t have electricity at home and haven’t for weeks.” She recommended that physicians prescribe these resources the same way they would medications.