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.