Shortfalls in health take years off the lives of all Americans and hurt our nation's economy, according to the Robert Wood Johnson Foundation (RWJF), which today announced the new Commission to Build a Healthier America. Mark McClellan, M.D., Ph.D., director, Engelberg Center for Health Care Reform at the Brookings Institution and former FDA commissioner and administrator of the Centers for Medicare & Medicaid Services, and Alice Rivlin, Ph.D., senior economist at the Brookings Institution and former director of the Office of Management and Budget, will co-chair the two-year commission.

The national, independent and nonpartisan health commission will focus on factors outside the health care system and identify non-medical, evidence-based strategies—both short- and long-term—to improve the health of all Americans. The group will investigate how factors, such as education, environment, income and housing, shape and affect personal behavioral choices through an extensive inquiry that will include regional field hearings. The commission members represent a diverse group of innovators and experts with the ability to cross traditional boundaries, mobilize partners to action and identify practical, timely solutions.

"America cannot continue to ignore that millions of people are sicker than they should be and dying far too young. The evidence tells us that whether or not a person gets sick in the first place often has little to do with their health care," said RWJF President and CEO Risa Lavizzo-Mourey, M.D., M.B.A. "A far greater determinant of a person's health is the relationship between how we live our lives and the surrounding economic, social and physical environment. This commission will take a fresh look at factors such as these to identify innovative ways to make ours a healthier nation."

As part of its work, the commission will identify solutions that are currently in place and working to improve Americans' health—projects like the Healthy Homes pilot program in King County, Wash., funded by the National Institute of Environmental Health Sciences. As part of the program, regular visits by community health workers reduce children's exposure to conditions in their homes that can cause asthma. The effort led to significant improvements in health and health care savings.

"For reasons that don't appear to have much to do with health care, there is a big gap between how healthy we are and how healthy we could be," said McClellan. "In fact, in some respects, wealthy Americans appear to be less healthy than middle income citizens of England. The commission will investigate practical strategies being developed and implemented around the country, in the public and private sectors, to strengthen our health and close the gap."

"The health of our people affects the overall health of our economy and our nation. While we must make health care delivery more efficient and broaden access to care, the medical system addresses only some of the factors influencing health," said Rivlin. "That is why I am so committed to the work of this commission. There is more to health than health care."

RWJF Delivers New Report on Health Differences

In addition to launching the commission, RWJF released a report delivered to the commission describing the current health profile of Americans and looking specifically at how education, income, race and ethnicity play a role in Americans' health. The report, Overcoming Obstacles to Health, by researchers at the University of California, San Francisco (UCSF), found that:

• Poor, less educated and minority Americans on average die up to six years earlier than their wealthier, better educated counterparts.
• Middle-class Americans on average die up to two years earlier than more affluent Americans.
• In addition to living longer, more affluent Americans and their children live healthier lives than middle-class and low-income American families.
• Compared with college graduates, adults who have not finished high school are four times as likely to be in fair or poor health.
• Compared with adults in the highest income group, poor adults are three times as likely to have a chronic illness such as asthma or diabetes.
• Children in the lowest income families are seven times as likely to be in fair or poor health compared with children in the highest income families.

Education plays a large role in health, the report shows. College graduates live longer and have better health than those with only some college or high school educations. College graduates outlive high school graduates by more than six years.

"These health gaps are exacting a huge human and economic toll," said lead report author Paula Braveman, M.D., M.P.H., director of the Center on Social Disparities in Health at the UCSF School of Medicine. "So often, they are the result of a chain of events that begins early in life. Poor education means people get lower paying jobs and live in unsafe neighborhoods with low-quality housing. They can't afford to buy healthy food. Living from paycheck to paycheck causes chronic stress. And, physical activity is a luxury. Together, these factors can produce poor health."

New RWJF Poll Finds Americans Seriously Concerned

A related poll released by the Foundation found that Americans are seriously concerned about differences in health—78 percent of those polled believe it is important to make sure that health differences no longer exist simply because of differences in income and education levels. And, 92 percent of those polled agree that improving the quality of education and education levels will improve quality of life and health status. Those surveyed also believe that policy-makers need to take a broader view of health and look beyond the debate on health care costs and access, and beyond the medical care system, for ways to improve health.

Those surveyed largely agree that current policies to address issues of education, health differences and job opportunities aren't working. In fact, only 33 percent of people surveyed feel that current government policies aimed at reducing health differences are working. And, only 40 percent feel that policies aimed at improving job opportunities are working.

The most vulnerable people in America view themselves as less healthy than others and see a great need for interventions that would allow them to pursue health. In fact, 66 percent of low-income individuals with lower levels of education believe that where and how people live, work and play has a greater impact on health than access to health care.

"It is clear across this data that in addition to personal behavior, Americans view social factors, such as income, education, and environment as having a significant impact on a person's health," says pollster Bill McInturff, partner and co-founder of Public Opinion Strategies. "But, despite the consensus that these health differences due to social factors are a problem and that current policies are not working, there are barriers that are preventing people from demanding action."

Additional information, a poll summary and a multimedia presentation of the personal stories presented in the report can be found on the commission's Web site www.commissiononhealth.org.

The Commission to Build a Healthier America is based at the George Washington University School of Public Health and Health Services in Washington, D.C. David R. Williams, M.P.H., Ph.D., a renowned social scientist and Norman Professor of Public Health and professor of African and African American Studies and Sociology, Harvard University, is the staff director of the commission. The research team for the commission's work is headed by distinguished health researcher Paula Braveman, M.D., M.P.H., professor of Family and Community Medicine at UCSF.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime.

Commission to Build A Healthier America Members

Mark B. McClellan
Director, Engelberg Center for Health Care Reform, the Brookings Institution and Senior Fellow, Economic Studies, the Brookings Institution

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

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 Wiener 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.

Sen. Bill Frist
Schultz Visiting Professor of International Economic Policy, Princeton University

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

Kati Haycock
President, Education Trust

Hugh Panero
Co-Founder and Former President and Chief Executive Officer, XM Satellite Radio

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

Dennis Rivera
Chair, SEIU Healthcare

Jim Towey
President, Saint Vincent College

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