Across America, Differences in how Long and how Well We Live

Essential as health care reform is, it will not be enough to close most of the gap between how healthy Americans are and how healthy they could be. Without urgent action to take proven steps that can make a big difference in health, America’s children could have sicker, shorter lives than their parents, according to a prominent national commission.

The Robert Wood Johnson Foundation’s Commission to Build a Healthier America today urged all Americans to make healthier choices and society to help remove the obstacles so many people face in making those choices, issuing 10 cross-cutting recommendations for improving the nation’s health. According to the Commission, how long and how well Americans live depend more on where we live, learn, work and play than on medical care, which accounts for only an estimated 10 to 15 percent of preventable early deaths. Building a healthier nation requires a broader view of health, the Commission said.

The Commission paid particular attention to crafting effective measures for meeting the needs of children and families. “To build a healthier America, it’s essential to put improving health front and center on the national agenda outside of health care and health programs,” said Commission Co-chair Mark McClellan, former head of the Food and Drug Administration and the Centers for Medicare & Medicaid Services. “Today’s children are at greater risk for a lifetime of poor health, limiting their opportunities for productive and long lives. This is unacceptable, but the evidence is clear that it doesn’t have to be that way.”

According to the Commission, Americans are not nearly as healthy as they should be—regardless of where they live and their income, education and racial or ethnic group. Good health begins with personal responsibility, but the nation’s health will not improve unless individuals do more to incorporate health into all aspects of everyday life, and unless leaders do more in their decision-making to support healthier decisions—from education to child care to community planning to business practices, the Commission said. The Commission spent a year exploring the state of America’s health and how health is shaped by where and how people live their lives. 

“Everyone must be involved in the effort to improve health because health is everyone’s business,” said Co-chair Alice M. Rivlin, former head of the White House Office of Management and Budget and the first director of the Congressional Budget Office. “People should make healthy choices by eating better, getting enough physical activity and not smoking. Communities and employers should support those choices by creating healthy environments. And the federal government should make and enforce healthy policies, like ensuring that all subsidized food is healthy and junk food is eliminated from schools.”

The RWJF Commission is a national, independent and nonpartisan group comprising innovators and leaders with a rich diversity of experience and depth of knowledge. The Commission’s charge was to focus on factors beyond medical care to identify practical and innovative strategies for improving the nation’s health.

The Commission’s recommendations are rooted in the twin philosophy that good health requires individuals to make responsible personal choices and society to remove the obstacles blocking too many Americans from making healthier choices and leading healthier lives. Given the seriousness of the nation’s economic downturn, the Commission also focused on developing proven and feasible recommendations that offer the strongest potential to leverage limited resources. Among the Commission’s key recommendations are:

  • Give kids a healthy start. Ensure that all children, especially very young children in low-income families, have high-quality education and child care. This means increasing federal government spending to support early childhood development for young children in low-income families. This recommendation is critical, because evidence is now very strong that early childhood has a tremendous impact on a person’s health across a lifetime. 
  • Ban junk food from schools. Feed children only nutritious foods in schools. Federal funds should be used exclusively for healthful meals.
  • Get kids moving. All schools (K-12) should include at least 30 minutes every day for all children to be physically active. Although children should be active at least one hour each day, only one third of high school students currently meet this goal.
  • Help all families follow healthy diets. More than one in every 10 American households lack reliable access to enough nutritious food. Federal supplemental nutrition programs should be fully funded and designed to meet the needs of hungry families with nutritious food.
  • Eliminate so-called nutrition deserts. Create public-private partnerships to open grocery stores in communities without access to healthful foods. Many inner-city and rural families lack this access; for example, Detroit, a city of 139 square miles, has just five full-service grocery stores.

“For too long we have focused on medical care as the solution to our health problems, when the evidence tells us the opposite,” said RWJF President and CEO Risa Lavizzo-Mourey, M.D., M.B.A. “We must make it possible for more people to make healthy decisions and avoid getting sick in the first place. The Commission has provided us with a principled, sensible and experience-driven blueprint. We cannot afford to wait to implement these recommendations.”

Social Factors Play a Dominant Role in Determining a Lifetime of Health

Some Americans can expect to die 20 years earlier than others just a few miles away because of differences in education, income, race or ethnicity and where and how they live.  On average, Americans who graduate from college can expect to live five years longer than those who do not complete high school. And they can expect to be healthier, too. People who are poor are more than three times as likely as those who are affluent to suffer physical limitations from a chronic illness.

The Commission’s report, Beyond Health Care: New Directions to a Healthier America, explains that many people live and work in circumstances and places that make good health difficult. Many very young children do not get the quality of care and support they need and grow up to be less healthy as a result; many Americans do not have access to grocery stores that sell nutritious food; still others live in communities that are unsafe or in disrepair, making it difficult or risky to be physically active. 

“While each of us must make a commitment to our own health, society must improve opportunities for choosing health, especially for those of us facing the most challenging obstacles,” said Rivlin. “We must acknowledge that some families and communities have a higher hill to climb than others. We cannot build a healthier America if we leave them behind.”

Commission Recommendations Link to Economic Stimulus Package

Several of the RWJF Commission’s recommendations reinforce elements of the economic stimulus package recently passed by Congress. For example, the new law provides additional funding for nutrition assistance to low-income families enrolled in the Supplemental Nutrition Assistance Program (SNAP), formerly Food Stamps. The law also provides an additional $500 million to the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). The Commission believes that adequate funding of SNAP and WIC is essential to ensuring that the nutritional needs of all families are met.

In addition, the stimulus package offers opportunities for states and communities to act on the Commission’s recommendations that health be incorporated into all facets of policy and decision-making. For example, when stimulus funds are to be used to rebuild roads, communities should also build sidewalks and bike lanes to expand opportunities for physical activity. 


Recommendations from the Robert Wood Johnson Foundation Commission to Build a Healthier America

  1. Ensure that all children have high-quality early developmental support (child care, education and other services). This will require committing substantial additional resources to meet the early developmental needs particularly of children in low-income families.
  2. Fund and design WIC and SNAP (Food Stamps) programs to meet the needs of hungry families for nutritious food.
  3. Create public-private partnerships to open and sustain full-service grocery stores in communities without access to healthful foods.
  4. Feed children only healthy foods in schools.
  5. Require all schools (K-12) to include time for all children to be physically active every day.
  6. Become a smoke-free nation. Eliminating smoking remains of the most important contributions to longer, healthier lives.
  7. Create “healthy community” demonstrations to evaluate the effects of a full complement of health-promoting policies and programs.
  8. Develop a “health impact” rating for housing and infrastructure projects that reflects the projected effects on community health and provides incentives for projects that earn the rating.
  9. Integrate safety and wellness into every aspect of community life.
  10. Ensure that decision-makers in all sectors have the evidence they need to build health into public and private policies and practices.

About the Robert Wood Johnson Foundation Commission to Build a Healthier America

The Robert Wood Johnson Foundation Commission to Build a Healthier America was asked to identify practical, feasible ways to reduce barriers to good health and promote and facilitate healthy choices by individuals, for themselves and their families. 

Commissioners solicited advice and information from experts, innovators, stakeholders and the public through activities including field hearings, public testimony, roundtable discussions, experts’ meetings and fact-finding site visits. Commissioners and staff met and consulted with elected and executive agency officials, representatives of business, advocacy and professional and policy organizations and members of the public. The Commission also solicited information about successful interventions through its Web site.  

The Commission reached consensus findings and recommendations through a series of internal meetings, monthly teleconferences and one-on-one discussions among Commissioners and with senior Commission and Foundation staff.

Mark B. McClellan
Director, Engleberg Center for Health Care Reform
Senior Fellow, Economic Studies and Leonard D. Schaeffer Director’s Chair in Health Policy, Brookings Institution

Alice M. Rivlin
Senior Fellow, Economic Studies Program, and Director, Greater Washington Research Program, Brookings Institution
Visiting Professor at the Georgetown Public Policy Institute

Katherine Baicker
Professor of Health Economics, Department of Health Policy and Management, Harvard University

Angela Glover Blackwell
Founder and Chief Executive Officer, PolicyLink

Sheila P. Burke
Faculty Research Fellow and Adjunct Lecturer in Public Policy, Malcolm Weiner Center for Social Policy, Kennedy School of Government, Harvard University

Linda M. Dillman
Executive Vice President of Benefits and Risk Management, Wal-Mart Stores, Inc.

Senator Bill Frist
University Distinguished Professor, Vanderbilt University

Allan Golston
U.S. Program President, The Bill & Melinda Gates Foundation

Kati Haycock
President, The Education Trust

Hugh Panero
Co-Founder and Former President and Chief Executive Officer, XM Satellite Radio
Venture Partner, New Enterprise Associates

Dennis Rivera
Chair, SEIU Healthcare

Carole Simpson
Leader-in-Residence, Emerson College School of Communication
Former Anchor, ABC News

Jim Towey
President, Saint Vincent College

Gail L. Warden
Professor, University of Michigan School of Public Health
President Emeritus, Henry Ford Health System

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