Can We Reach Our Health Potential?

During the past four months, healthcare reform legislation has been a shining light on the need to improve preventive care and primary care services for those in need. Who can really argue about this quest to provide quality care? But, a nagging feeling exists that many Americans need more to reach their "unrealized health potential."

In a commentary out this week from Health Affairs, several prominent health policy experts revisit the idea of how the culture of care may influence healthcare delivery more than many people may admit. They draw their discussion in part from recommendations issued a year ago from the Robert Wood Johnson Foundation's Commission to Build a Healthier America on "New Directions to a Healthier America."

The commentators note that there is no question "that medical care is essential for relieving suffering and curing illness." However, medical care prevents only 10% to 15% of premature deaths, they say. Instead, research shows that social (and cultural) factors—including education, income, and the quality of neighborhood environments—play a prominent role "in shaping our health than medical care does," they write.

For instance, college graduates can expect to live five years longer than those who don't complete high school. And, if everyone enjoyed the same good health as college graduates, the national economy would achieve an annual average savings of $1 trillion, they say. At the same time, longer and healthier lives would result in higher workforce productivity, reductions in expenditures on social programs and increases in tax revenues. 

Mark McClellan, MD, PhD, the former head of the Centers for Medicare & Medicaid Services, said a year ago when the report was released:

"The evidence is clear that how we live, learn, work, and play has a much greater influence over how well and how long we live than our healthcare," 

"It's time to take a wider view of what we need to do to improve our health," says McClellan, who is now director of the Engelberg Center for Health Care Reform at the Brookings Institution in Washington.

So, what needs to go on outside the medical system to help improve healthcare in the future? The experts make a number of suggestions, based on the work of the commission, to promote a national culture of health which include:

• Designing public programs that support the needs of hungry families for nutritious foods.
• Eliminating smoking and promoting a smoke-free nation.
• Giving children, especially those from low-income families, a healthy start by ensuring that they have high-quality education and child care.
• Getting children to be physically active at least an hour every day.    
• Banning junk food from schools.

As the commentators note, new inroads are being made in some of these areas. For instance, at the federal level, new cooperative health efforts are being undertaken—such as seen with a recent announcement by the Department of Health and Human Services of a $650 million community prevention and wellness initiative to promote more physical activity, better nutrition, and reductions in obesity and smoking.

And, more publicly, the challenge has given rise to First Lady Michelle Obama's "Let's Move" campaign, which aims to end the epidemic by increasing understanding of nutrition, encouraging schools to provide healthier food, and promoting physical
activity.

So it's a start. While advances in medicine are important, when it comes to population health, it's our actions and choices that will make the biggest difference in the quality of our health lives.