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April 02, 2009

On Improving America's Health

The RWJF Commission to Build a Healthier America, which we've mentioned numerous times here on MH Blog, has released its Recommendations, contained in a report entitled, appropriately, Beyond Health Care: New Directions to a Healthier America.

From the Executive Summary:

Making America healthier will require action at all levels of society. Individuals, communities, health care, businesses and unions, philanthropies, and local, state and the federal government must work together to improve our nation’s health. Although medical care is important, our reviews of research and the hearings we’ve held have led us to conclude that building a healthier America will hinge largely on what we do beyond the health care system. It means changing policies that influence economic opportunity, early childhood development, schools, housing, the workplace, community design and nutrition, so that all Americans can live, work, play and learn in environments that protect and actively promote health. 

Indeed.  I enthusiastically agree.  The distinction between health and health care is a horse I will continue to flog, especially when one examines the recent issue of Health Affairs.  HA, of course, is a primary if not paramount health policy journal, and to their credit, published an excellent theme issue on the SDOH exactly one year ago (March/April 2008).  But if one looks at the current HA, it features a set of Web Exclusives, all discussing health care reform.  Amidst these commentaries, there is a short article by Gail Wilensky and David Satcher (both Commissioners in the WHO Commission on the SDOH) entitled, sadly, Don’t Forget About The Social Determinants Of Health.

The article begins by noting the intensity of the attention and focus on health care delivery and financing since President Obama took office, and then states that

Although there is a clear need to improve the performance of the delivery system, the two of us are hopeful that the country will begin to recognize the importance of an even more fundamental set of issues: the so-called social determinants of health.

It is somewhat sad to me that an "even more fundamental set of issues" that promotes or impedes population health -- the SDOH -- is relegated to something that must be almost pleaded lest it be forgotten.  Why are we in a state in which the most important determinants of health and illness are at risk of being forgotten???

I have some ready answers to this question, but none that satisfy me from a normative perspective.

In any case, the RWJF Commission's Report certainly seems like a step in the direction I think we ought to be moving in, and may even be responsive to Wilensky and Satcher's plea here.  I may come back with more commentary once I have had a chance to digest the full report.  You can download the Executive Summary and the full Report here, free of charge. 


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