According to the World Health Organization, someone born in
the United States will not, on average, live as long as someone born in
England, Sweden, Spain, Norway, Malta, Netherlands, France, Finland, and other
countries, even though we spend more than they do on health care.
In fact, we spend more than any other country on health
care, but rank at the very bottom among the wealthiest countries on the quality
of our health care system. (The United Kingdom, ranked in first place, spends
only about 40% of what the United States spends, yet achieves such better
health for its population.)
We’re not the happiest country, either – with a rank of 17
in a 2013 United Nations report. Interestingly, the countries where people live
the longest also tend to have the highest levels of happiness.
How can our bodies and our spirits get into better shape?
In thinking about health, we often jump immediately to
health care. However, effective health care probably only accounts for about 20
percent of the reasons why we are healthy (or not). Our health depends on much
more. The condition of our bodies, the illnesses that afflict us, and even how
long we live depend largely on the social determinants of health. These social
determinants include our housing, our income, our education, the availability
of nutritious food, air quality, the level of crime in our neighborhood,
facilities to promote physical activity, and other aspects of our environment.
In short, many of the factors that lead to illness, or promote good health, lie
outside of the health care system.
The President of the Robert Wood Johnson Foundation recently
invited me to attend a meeting, to discuss how we can transform thinking and
action in this country to promote health. The Foundation has worked intensively
on a major initiative to “build a culture of health” in the United States They
have traveled the country, delivering lectures and participating in meetings,
including three, annual Healthy Communities conferences in Minnesota, organized
by Wilder Research and the Federal Reserve Bank of Minneapolis.
The movement to build a culture of health predicates itself
on the premise that promotion of health, in the words of the Robert Wood
Johnson Foundation, “must place well-being at the center of every aspect of
American life.” The movement focuses on “the key influences of factors found in
communities, business and corporate practices, schools, and the many other
spheres of everyday life.”
Think about it. The sick leave policies of our nation’s
businesses directly enable us to achieve better health by offering the
opportunity to rest and to fight an illness that strikes us. Indirectly, those
policies keep us healthier by enabling sick people to stay home and recover
rather than feeling compelled to work and coincidentally to infect us.
Government decisions to create or protect space for physical activity enable us
to maintain a healthier lifestyle. Sick leave policies and greenspace policies strongly
influence our health, yet neither falls into “health care policy” in the
traditional sense.
So, we will likely
see the culture of health movement take action in four areas.
For one, we’ll see increased emphasis on making health “a shared value.”
That means developing a public mindset about health as a
fundamental building block of our communities. Developing such a mindset will
require education, attitude shifts, and social interaction to motivate our
population to want to improve health on their own and with others.
We will see increased emphasis on fostering cross-sector collaboration
to improve health.
That means that members of the traditional health care
system – doctors, hospitals, health plans, etc. – will collaborate more with
people and organizations outside of health care. Health departments might work
with banks who want to finance preschool education facilities and community
health clinics. Units of state government such as transportation, housing, and
natural resources will take action jointly with the state health department to
shape policies and programs which promote health. Ed Ehlinger, Minnesota’s Commissioner of Health stands out as a national leader in terms of promoting collaboration and
infusing “health into all policies.”
We will see increased energy and resources devoted to changing our
environments.
Even the best motivated, most well-intended individuals
cannot ensure optimal health on their own. Without access to healthy food,
people cannot provide suitable nutrition to themselves and their families;
without affordable housing, some families cannot achieve stability and ensure
good education for their young members; without feeling safe on the street,
individuals cannot engage in health promoting activities, plus they have
greater likelihood of suffering injury or death.
Finally, in the movement to promote a culture of health, we will see
efforts to strengthen and integrate the system of health care services on which
we rely.
We will see action taken to improve the access of people to
health care, to improve patients’ experience, to contain costs without
compromising quality, to improve outcomes for all, and to focus on prevention.
Can we achieve the levels of health and happiness of other
major nations? Can we eliminate the disparities in health which now exist among
groups in the United States? Focusing attention on building a culture of health, including work in the above four action areas of interest to the Robert Wood Johnson Foundation, can hopefully move us in that direction.
