Tuesday, August 3, 2010

Improving America's Health

In the August issue of Health Affairs (vol 29, no8 pages 1481-88), David Williams and colleagues summarized the report of the Robert Wood Johnson Foundation Commission to Build a Healthier America. Much of the focus of this report is on the need for actions at all levels of society to promote the development and maintenance of health rather than depending on the health care system to treat Americans after the onset of major diseases. Acknowledging that medical care prevents only 10 to 15% of premature deaths the commission advocates a range of policy and behavior changes that will promote health. The major emphasis is on early childhood and healthy growth. Initiatives could focus on children through prevention of childhood obesity, emphasis on physical activity, and healthy nutrition. Such child development clearly needs a supportive healthy community to sustain active lifestyles, avoid the uptake of cigarette smoking, and maintain healthy growth and development among children and adolescents. The commission clearly makes the case for improvement in health through documenting substantial gaps between the United States and other developed countries. These gaps in measures of health persist, but are reduced, with increases in income and education. Even the best off Americans are behind citizens of other countries in many key health measures.

In a manner similar to this commission, Australia has developed a framework for preventive health and established goals to position the country as the healthiest nation in the world by 2020 (see report and detailed strategy). In both countries, it is clear prevention and sustaining healthy lifestyles requires action both through the healthcare system and in the broader community including workplaces, schools, and neighborhoods. Only when we address prevention across individual behaviors, social determinants of behavior, and broader social supports for healthy lifestyles, will the US begin to approach the levels of health and wellness that many of the other countries in that the leading economies of the world have already achieved.

Education is a key variable that drives much of ones lifetime trajectory for health and wellness. The Robert Wood Johnson report clearly articulates the importance of bringing many areas, including education, to the table to better inform strategies to achieve improved population health. We have much potential to build on examples of local initiatives that have successfully improved nutrition and physical activity and development of children (Gortmaker, Cheung et al. 1999). Workplace interventions have also improved diet (Sorensen, Stoddard et al. 1999), reduced smoking(Sorensen, Rigotti et al. 1991), and reduced risk of cancer and other chronic diseases (Colditz 2002; Sorensen, Stoddard et al. 2002). Applying these lessons more broadly throughout the country court substantially improve the health of all Americans (Colditz 2002). The challenge we face as a nation is bringing these advances to the whole of our society. The Affordable Health Care act is but one tiny and necessary step to improving the health of our nation.

References

Colditz, G. (2002). "Disseminating research findings into public health practice." Cancer Causes Control 13(6): 503-504.
Gortmaker, S. L., L. W. Cheung, et al. (1999). "Impact of a school-based interdisciplinary intervention on diet and physical activity among urban primary school children: eat well and keep moving." Arch Pediatr Adolesc Med 153(9): 975-983.
Sorensen, G., N. Rigotti, et al. (1991). "Effects of a Worksite Non-Smoking Policy: Evidence for Increased Cessation." Am J Public Health 81: 202-204.
Sorensen, G., A. Stoddard, et al. (1999). "Increasing fruit and vegetable consumption through worksites and families in the treatwell 5-a-day study." Am J Public Health 89(1): 54-60.
Sorensen, G., A. M. Stoddard, et al. (2002). "A comprehensive worksite cancer prevention intervention: behavior change results from a randomized controlled trial (United States)." Cancer Causes Control 13(6): 493-502.

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