Making 'The World Around Our Patients' a Healthier Place

    • August 28, 2012

Before he went to medical school, Matthew Levy majored in political science. After graduating from New York Medical College, young Dr. Levy kept a foot in both the clinic and the community: While earning a master’s degree in public health from Johns Hopkins University, he did a fellowship in community pediatrics and child advocacy at Georgetown University Hospital. He founded a mobile clinic program that went into inner-city Washington, D.C.; set up a school-based health center at a struggling high school, and built a student-run medical clinic in a homeless shelter.

“I had dedicated my career to building programs that improved access to care, finding the best approach in a particular situation,” says Levy, MD, MPH, FAAP. So when he was named a Robert Wood Johnson Foundation (RWJF) Health Policy Fellow (2010-11), “it was a natural progression, a chance to work on system-based change.” The fellowship gave Levy the opportunity to shape the policy debate on America’s obesity epidemic, first through work on a Senate staff and then as an advisor to a major bi-partisan health initiative.

Founded in 1973, the RWJF Health Policy Fellowship program is administered by the Institute of Medicine, the health arm of the National Academy of Sciences. It brings health professionals and scientists to the nation’s capital for residencies of a year or more, to work on policy at federal agencies and in the legislative and executive branches. 

“I had always been interested in the bigger picture, in maximizing what policy can do to keep people healthy and productive,” Levy says. “I think it’s essential to understand the interplay between clinical medicine and public health, to connect all the dots. I believe that, as clinicians, we can no longer afford to live in just the moment with our patients. We have to also understand the world around our patients, how it will affect the way that they heal and the way that they thrive.”

As an RWJF Health Policy Fellow, Levy worked on the Senate Budget Committee with the staff of U.S. Senator Kent Conrad (D-N.D.), the committee’s chairman. “It was an absolutely amazing experience, and I learned a lot,” Levy says. Given his “connecting the dots” approach, it was particularly valuable to see how budget considerations influenced policy on a number of RWJF concerns, from public health and vulnerable populations to how health professionals are trained for emerging crises such as the obesity epidemic.

“The amazing thing about the Health Policy Fellowship is that it takes what you already had built as a career, as a knowledge base and an understanding of your world, and pulls you out of that completely,” Levy adds. “It throws you into the policy world, this world that is completely different. And then it helps you integrate all this new information you’re learning with what you’ve known before.”

“You always hear that the fellowship will be ‘transformational,’ and at the beginning you’re like, ‘Okay, that’s nice,’” Levy says now. “But then at the end of it, you really are in a different state: You have moved way past where you were, and you see things differently. And it happens to every fellow—not a few of them, but every single one.” In Levy’s case, he says, one revelation from his fellowship was “how important it is for physicians to advocate for better policies. As physicians, we potentially have a fair amount of influence in the creation of good policies that lead to good programs. As a profession, I think we don’t always maximize that influence.”

During his fellowship, Levy met Robin Schepper, then executive director of Let’s Move!, the obesity-fighting campaign spearheaded by First Lady Michelle Obama. Schepper left the White House to work at the non-profit Bipartisan Policy Center (BPC) on its Nutrition and Physical Activity Initiative, a project underwritten by RWJF, the W.K. Kellogg Foundation, and the Stuart Family Foundation. Schepper invited Levy to become a part-time advisor to the Initiative and, with RWJF’s support, Levy accepted.

An excerpt from “Lots to Lose: How America’s Health and Obesity Crisis Threatens our Economic Future” explains why the report calls obesity “the most urgent public health problem in America today”:

“Fully two-thirds of Americans are overweight or obese. One-third of American children are overweight or obese. And among children under the age of six, nearly one in five is overweight or obese. Obese people are far more likely to develop chronic diseases like diabetes, hypertension, asthma, heart disease and cancer…. (Obesity) is a primary reason why life expectancy in large parts of the United States is already several years lower than in other advanced countries around the world…. More broadly, the costs of obesity and chronic disease have become a major drag on our economy. Escalating health care costs are the main driver of our spiraling national debt, and obesity-related illness comprises an increasingly large share of our massive health costs…. For our nation as a whole, the impacts of America’s obesity epidemic jeopardize our global competitiveness and national security, directly undermining our ability to cut the federal debt, prepare and sustain a highly productive workforce, maintain our military strength, and compete effectively in the global economy.”

A Commitment to Fighting Obesity

In a year-long effort to encourage healthy eating and physical activity, the Initiative interviewed and brought together issue experts, policy-makers, and stakeholders from groups as diverse as the American Hiking Society and the American Academy of Pediatrics. A report of its findings, published in June 2012, describes obesity as “a public health crisis so profound that it is undermining our national well-being, our economic competitiveness and even our long-term national security.” The report—entitled “Lots to Lose: How America’s Health and Obesity Crisis Threatens our Economic Future”—recommends ways to fight obesity at the levels of families, schools, workplaces, and communities, and cites examples of promising efforts underway around the country.

The report’s Healthy Families section was a particular focus of Levy, who is an Associate Professor of Clinical Pediatrics at Georgetown University School of Medicine as well as Division Chief  of Community Pediatrics at MedStar Georgetown University Hospital. The report notes that currently, the federal government offers dietary guidelines for Americans starting at age two and physical activity guidelines starting at age six. “Given the importance of establishing healthy patterns for diet and activity in very young children,” the report suggests, the federal government should develop and promote new dietary guidelines “for the first thousand days, covering pregnant women and children up to two years old,” as well as physical activity guidelines for children as soon as they are mobile.

Levy also contributed significantly to the Initiative’s Healthy Communities research, and specifically its recommendations about training health care providers to promote nutrition and physical activity. “I worked with lots of different folks around the country who are the experts not only in those issues but also in the behavioral drivers of education—what will drive us, as a profession, to do this,” Levy says. In part, he says, “It’s a matter of understanding that discussing obesity is not an optional thing anymore—it’s a crisis and we have to address it head-on. Members of the provider community can have a very strong influence on patients, but only if they’re well-prepared to talk about this issue.” The Initiative report recommends that “Nutrition and physical activity training should be incorporated in all phases of medical education—medical schools, residency programs, credentialing processes, and continuing education requirements.” 

Since the report was released, Levy says, he and others at BPC have been “reaching back out” to the scores of organizations that participated in the Initiative to encourage action on its recommendations. Levy says he was encouraged to hear that the National Institutes of Health, through its National Heart, Lung and Blood Institute, is planning a summit to promote nutrition education programs in medical schools and has asked BPC to participate.  

“It’s exciting, to see the beginning of the embodiment of what we put in our recommendations,” Levy says. “By producing a comprehensive report that touched on all sectors, we've really said, ‘Look, everyone can have a part in this, and it’s going to take all of us to make this happen. And we have to do this because as a country, we need that competitive edge, and we are losing it because we are so unhealthy.’”

Through the work on Capitol Hill and with the Initiative, “the fellowship gave me the tools to reinvent myself, to be able to be involved on these issues at all levels,” Levy says. So after his current work ends in September, he says, “I’m going to continue to dedicate time to advancing the Initiative, because I think it’s that important.”