Prevention Matters

The passage of the Affordable Care Act created a renewed emphasis on community prevention and population health. With the Prevention and Public Health Fund and the Community Transformation Grants, resources are now available to improve the health of communities around the country. But how do you know how healthy your community is?

On Wednesday, the Robert Wood Johnson Foundation (http://www.rwjf.org/) and the University of Wisconsin Population Health Institute (http://uwphi.pophealth.wisc.edu/) released the 2011 County Health Rankings (http://www.countyhealthrankings.org/). The County Health Rankings are a key component of the Mobilizing Action Toward Community Health (MATCH) project—a nationwide call to action for improving community health—first released last year. The rankings generate 50 state reports, ranking each county within the 50 states according to its health outcomes and the multiple health factors that determine a county’s health. The four different types of health factors are health behaviors, clinical care, social and economic factors, and the physical environment. Specific county-level data (as well as state benchmarks) are also available. The Rankings are built on America’s Health Rankings, an annual comprehensive assessment of the nation’s health on a state-by-state analysis, which is published jointly by United Health Foundation, the American Public Health Association and Partnership for Prevention.

Many counties around the country have used the Rankings to implement strategies and initiate interventions to positively influence health factors and improve their health outcomes. One specific example is Wyandotte County, Kansas, where Mayor Joe Reardon worked with other local stakeholders to create a Healthy Communities initiative after seeing his state’s low rank in last year’s County Health Rankings report.

A new development with this year’s Rankings is the launch of an innovative tool, the County Health Calculator (http://chc.humanneeds.vcu.edu/). The calculator is a new interactive online application that simulates the affect of higher levels of education and income on health in a county. It was developed by Center of Human Needs at Virginia Commonwealth University (http://humanneeds.vcu.edu/) with funding by Robert Wood Johnson Foundation.

Read more on Partnership’s community prevention efforts here.

Yesterday, the Robert Wood Johnson Foundation launched a new interactive map that provides the latest data on tobacco policies by state. Using information courtesy of the Americans for Nonsmokers’ Rights and the Campaign for Tobacco-Free Kids, the map focuses on three different aspects of tobacco policy: 1) smoke-free laws; 2) cigarette tax rates; and 3) tobacco control spending. “Users will be able to see whether a state is ahead or behind the curve in protecting and promoting health,” says Michelle Larkin, J.D., M.S., R.N., leader of RWJF’s Public Health Team.

With its array of colors and pop-up menus, the map points out that Rhode Island and Connecticut have the highest tax rates in the U.S.--$3.46 and $3.00, respectively. The map also shows that North Dakota is the only state that spends 100% or more of state funding for tobacco control relative to the Centers for Disease Control and Prevention recommendations.

Brandi Robinson
Program Associate, Partnership for Prevention

Millions of adults living in the U.S. are not up to date on their needed immunizations, leaving them at risk for preventable illnesses and even death, according to a new report released by Trust for America’s Health (TFAH), the Infectious Diseases Society and the Robert Wood Johnson Foundation.

According to the report, key reasons for the low immunization rates include a lack of knowledge about the safety and effectiveness of vaccines, limited access to immunization and limited research and development of new vaccines in the United States.

The Robert Wood Johnson's Commission to Build a Healthier America was launched in February 2008 to find out why Americans aren’t as healthy as they could be and to suggest ways outside the health care system to improve health for everyone.

The commission is wrapping up its duties and closing its doors after two years in which it has issued two major, held regional field hearings, national events and more than 50 meetings with public and private sector leaders.

"This Commission was not the first time this country has addressed health disparities or the social determinants of health – but it’s the first time in a long time that we have been able to look at these issues squarely in the face and have hope," says RWJF President/CEO Risa Lavizza-Mourey.

"The Commission crystallized for all of us that health is more than health care. Health is where and how we live, learn, work and play," she says. "So, reaching beyond traditional health care communities is essential if we are going to make any headway in improving the health of all Americans."

Lavizza-Mourey further discusses the closing of the commission and the importance of its work in a recent podcast.

The Robert Wood Johnson Foundation and Trust for America’s Health have released a new poll showing that 71 percent of Americans favor an increased investment in disease prevention and that disease prevention is one of the most popular components of health reform.

The poll, conducted by Greenberg Quinlan Rosner Research and Public Opinion Strategies, indicates majority support for disease prevention investments from across the political spectrum (85 percent of Democrats, 59 percent of Republicans, and 68 percent of Independents) and across the country (72 percent in the Northeast, 73 percent in the South, 71 percent in the West, and 69 percent in the Midwest).


According to the survey, 70 percent of people think prevention will save money rather than cost money. Nearly two-thirds of Americans ranked investing in prevention between an 8 and 10 on a scale of 0 to 10, where 0 means not at all an important health care priority and 10 means very important.

The Robert Wood Johnson Foundation RWJF) says it will support an independent evaluation of part of an industry effort to help reduce obesity.  A coalition of more than 40 retailers, non-governmental organizations and food and beverage manufacturers announced on Oct. 5 the launch of the Healthy Weight Commitment Foundation (HWCF), a national, multi-year effort designed to help reduce obesity—especially childhood obesity—by 2015. The HWCF will promote ways to help people achieve a healthy weight through energy balance. It focuses on three critical areas—the marketplace, the workplace and schools.

RWJF will fund an independent group of scientists who will define the measures that will be used to track progress of the marketplace program and determine whether it is making a significant difference for the nation’s children.

The Robert Wood Johnson Foundation's Paul Tarini says consumer product companies and retail chains a source for "big innovation" in health and health care that are worth watching.

"Think Procter & Gamble, Best Buy and Wal-Mart," Tarini writes in RWJF's "Pioneering Ideas" blog. "When you move the focus from detection and treatment to prevention and wellness, there are lots of opportunities to develop products and services and relationships that improve health, extend life and don’t require medical professionals.

"I can imagine a whole bunch of consumer products and services that focus on wellness. And once established in that market, it’s not too big a step for these companies to begin to offer products and services that do require medical professionals…it’s already happening with minute clinics."

The Robert Wood Johnson Foundation has published research on efforts by California school districts to encourage healthy eating and physical fitness among its students.


Findings from online surveys and focus groups, as well as interviews with school board members, leaders of state associations of school boards, state directors of nutrition and school wellness advocates
identified the following as the most significant barriers to effective school wellness policies:

• Inadequate funding, such as for staff and facilities, to implement and monitor a policy.
• Competing priorities and lack of time.
• Lack of support from students, parents and the community.
• A need for tools and training.

A new report from the Institute of Medicine and National Research Council outlines strategies that local government officials can use to tackle the childhood obesity epidemic in their communities. They include zoning restrictions on fast-food restaurants near schools and playgrounds, community policing to improve safety around public recreational sites, requirements that publicly run after-school programs limit video game and TV time, and taxes on high-calorie, low-nutrient foods and drinks.

The report highlights several examples of ways that officials have promoted healthier lifestyles in communities ranging from big cities to small towns. It also recommends starting points that could help officials initiate childhood obesity prevention plans tailored to their jurisdictions' resources and needs.

The Robert Wood Johnson Foundation's James Marks challenges the Congressional Budget Office's scoring rules in a column appearing in The Huffington Post. Because those rules exclude any returns on health investments that occur after 10 years, the CBO attributes no budget savings to early childhood inteventions and investments in early detection and prevention -- all of which generally show gains well beyond the 10-year window.

"Benjamin Franklin once famously remarked, 'An ounce of prevention is worth a pound of cure,' Marks wrote. "Unfortunately, what this means is often, according to the CBO, an ounce of prevention isn't worth anything at all."

"...as a doctor, and more specifically, a pediatrician, I know these truths to be self-evident: a society that fails to invest in its children will not flourish, and merely scoring costs in the short term and not determining the value of health in the long term has helped us have the most expensive medical care in the world with a shorter life span than all our competitors," he said.

A new study shows that most states still aren't making good use of tobacco control tools that have been proven to work.

According to the report - Cigarette Smoking Prevalence and Policies in the 50 States: An Era of Change -- the Robert Wood Johnson Foundation ImpacTeen Tobacco Chart Book -says a combination of outreach programs, legislation, cigarette price increases and coverage for and access to stop-smoking treatments has been proven effective in reducing smoking rates and protect nonsmokers. Even so, there is wide variation in cigarette smoking prevalence across states and a clear relationship between smoking prevalence and the rate of mortality that can be attributed to smoking.

For example, approximately 27 percent of adult Medicaid recipients were smokers in 2006 - significantly higher than the 17 percent rate among adults with private insurance. But in that same year, Medicaid programs in a dozen states still did not provide coverage for proven tobacco treatment to their clients who smoked.

A new survey shows that Americans overwhelmingly support increasing prevention funding, even if it doesn't save money. The survey, commissioned by Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) found that 72 percent of those surveyed agree with the statement that "investing in prevention is worth it even if it doesn't save us money, because it will prevent disease and save lives."

Poll participants ranked prevention as the most important health care reform priority. Seventy percent ranked it between an eight and 10 on a scale of zero to ten, where zero means not at all an important health care priority and 10 means very important. Forty-six percent rated prevention as a 10 out of 10. Overall, prevention was rated higher than all other proposals, including providing tax credits to small businesses and prohibiting health insurers from denying coverage based on health status.

The poll, conducted by Greenberg Quinlan Rosner Research and Public Opinion Strategies, found that 86 percent of Democrats, 71 percent of Republicans, and 70 percent of Independents supporting investing more in prevention. It also found that 77 percent of Americans agreed with the statement that "prevention will save us money."

Partnership for Prevention President Robert J. Gould took part in a press conference with TFAH yesterday to say the results are consistent with Partnership's experience working with corporations to establish worksite wellness programs.

"The public gets it and CEOS are getting it," Gould said. "One of the most hopeful trends in disease prevention and health promotion over the past several years has been the movement among corporations to promote health and wellness through worksite-based programs. More companies "are taking proactive measures to improve the physical health of their employees and the fiscal health of their organizations," he said.

To view video of Gould's remarks, click on the media player below. If you don't see a media player, click here.

Anyone familiar with Partnership for Prevention’s work and activities knows that “real health reform starts with prevention.” Implicit within this assertion is the conviction that the issue is health reform, not just health care reform. Partnership has always promoted this idea-it is the central premise of our Principles for Prevention-Centered Health Reform and all of our health reform recommendations.

Robert Wood Johnson Foundation’s Commission to Build a Healthier America further developed this theme with the release April 2 of its 10 recommendations for improving the nation’s health. By concentrating on evidence-based interventions and programs that are outside the health care system, the Commission emphasizes the need to have a broader view of health to generate a healthier nation.

Three aspects of the recommendations are particularly worth noting:

• The Commission addresses the main causes of poor health. Half of the recommendations deal directly with the three primary actual causes of death in the United States-smoking, poor diet, and physical inactivity;
• The Commission focuses on working as “upstream” as possible in the age continuum. Determinants of health and health behavior habits start early in life, therefore any policy or program implementation must begin with our children; and
• The Commission recognizes the role that non-health factors play in the health of the country. Policies related to transportation, housing, infrastructure, agriculture, and the environment all have a “health impact,” and developing healthy communities requires measuring that impact.

Finally, these recommendations are consistent with Partnership’s emphasis on the significance that community prevention plays in health reform, and we look forward to collaborating with the Commission and other partners to advance interventions that will have a greater impact on health than increased access to medical care, improved health insurance coverage, less medical errors, or health IT. As we say in our principles, “The nation will get a much greater return on investment by focusing on health improvements in communities, schools, and worksites rather than focusing solely on what occurs in traditional healthcare settings, such as doctors’ offices and hospitals.”

Read more on Partnership’s health reform efforts at www.prevent.org/healthreform. The Commission to Build a Healthier America’s recommendations can be found on its website at http://www.commissiononhealth.org/.

- Jason Spangler, MD, MPH

In 2008, states received $17.60 per person on average from the U.S. Centers for Disease Control and Prevention (CDC) to spend on disease prevention and health promotion. But a new report from the Trust for America's Health and the Robert Wood Johnson Foundation shows that the difference in funding to individual states differed by as much as $40 per resident.

Alaska received the most funding from CDC of any state at $52.78 per person in FY 2008, while Indiana received the least at $12.74. The report shows that Midwestern and Southern states received less funding from the federal government than Northeastern and Western states.