HEALTH REFORM: Building A Healthier America

Earlier this week, the Robert Wood Johnson Foundation's Commission to Build a Healthier America released a new report titled: "Beyond Health Care: New Directions to a Healthier America."

The first post we ever wrote for this blog was for the launch of the Commission to Build a Healthier America, which was created to "raise awareness of the factors beyond medical care that affect a person's health and recommend viable short- and long-term strategies to help improve the health of all Americans." They made their point brilliantly with a chart that looked like the D.C. metro-map showing the large variations in average lifespan in just a few miles between metro stops. Those disparities reflected differences in wealth, education and environment—in short, the social determinants of health beyond medical care. Over at RWJF's health reform blog, Jim Marks, a pediatrician and director of the RWJF's health group, elaborates:

What do we mean by, beyond medical care? There is a ton of evidence that shows where and how people live, where they go to school, how we go about the daily business of our lives—all of that has an effect on our health. And overall, these effects are HUGE. And the thing is, we tend to frame the daily business of living, and how it affects our health, solely as a matter of personal choice and personal responsibility.

Personal choice does play a role in my health and everyone's health. I can decide, for example, to have a bowl of ice cream for dessert instead of fruit. People can make choices about being physically active and avoiding risks like smoking.

But at the same time, many of us have fewer choices than others. If it's already hard to say no to the bowl of ice cream or the cheeseburger, how much harder is it if there's no grocery store with good produce or farmers' market in your area? If it's already hard to help your kids stay away from junk food, how much harder is it when schools are serving them unhealthy food and snacks—in effect teaching them that this is what they should eat?

Recognizing the shared responsibility of individuals and society to address this issue, the report identifies ways to encourage those choices that promote good health. Many of the recommendations focus on children—removing junk food from schools and ensuring kids are physically active for at least 30 minutes a day. One proposal calls on public-private partnerships to open grocery stores in communities without access to healthful foods. For example, Detroit, a city of 139 square miles, has just five full-service grocery stores. Maggie Mahar takes an extensive look at the report over at HealthBeat. We'd also suggest looking at the work Cass Sunstein and Richard Thaler have done on "nudges" or choice architecture, the way seemingly small, even arbitrary design decisions can have a large impact on the way we live and the actions we take. From smarter cafeterias, to providing vouchers for fruits and vegetables at farmers markets, they continue to document on Nudge blog, small changes that have the potential for big impact on the lives and health of individuals.