Prevention Matters

CQ reports that President Obama told Democratic members of the two Senate committees in charge of health care legislation that completing an overhaul of health care is “not a luxury” and that the period from now to August is the “make or break period.”

With that in mind, CQ says, Senate Democrats intend to move a single health care bill to the floor within weeks.

For the first time in our nation’s history, today’s generation of children may well live sicker, shorter lives than their parents. To improve America’s health, we need to understand why, across social boundaries and in every community, so many Americans are getting sick in the first place.

To answer that question, the Robert Wood Johnson Foundation Commission to Build a Healthier America spent the last year and a half investigating the powerful influence that factors beyond health care – where we live, learn, work and play – have on our health. As staff director, I had the privilege of joining the diverse group of commissioners in talking with experts, leaders and citizens across the country as the commission developed its recommendations.

We have good news: From business to government and at all levels of society, leaders and citizens are collaborating to remove obstacles that prevent people from making healthy choices. Where communities have mobilized to improve their health, we found grocery stores well-stocked with nutritious food, streets that were safe to walk, housing that was maintained, workplaces that promoted wellness, and a commitment among schools, child-care centers and parents to give all children in the community a chance to grow up healthy.

The commission released its recommendations in April to highlight these local successes. But the commission did not stop at identifying programs and policies and learning why they work. As Partnership for Prevention understands well, great ideas will go nowhere without equal efforts to educate decision-makers and engage stakeholders towards action. To that end, the commission is actively facilitating collaboration across communities, businesses, unions, philanthropies, and local, state and federal governments to help bring the recommendations to life.

Specifically, the commission recommends:

• Making education and high-quality child care a national priority


• Banning junk food in schools. Federal funds should be used exclusively for healthful meals


• Getting kids moving. All schools (K-12) should include at least 30 minutes every day for children to be physically active


• Eliminating so-called food deserts. Create public-private partnerships to open grocery stores in communities without access to healthful foods


• Creating incentives for healthy, safe development by assigning a health impact rating to housing and infrastructure projects


• Providing employees opportunities to make healthy choices in the workplace


• Protecting us all from tobacco smoke. Eliminating smoking remains one of the most important contributors to longer, healthier lives

You can read all the recommendations and learn more about model programs at commissiononhealth.org.

Building a healthier America is feasible in years, not decades, if we collaborate and act on what is making a difference. I encourage you to read the commission’s recommendations and to do your part to make America’s health a place of progress once again.


Dr. David R. Williams is a Professor of Public Health at the Harvard School of Public Health and the Staff Director for the Robert Wood Johnson Foundation Commission to Build a Healthier America.

Atul Gawande has an incisive piece in The New Yorker on what accounts for the vast differences in per capita Medicare spending in different parts of the country. He focuses on McAllen, Texas, where the average annual Medicare expenditure per patient exceeds the average annual income and is double that of Medicare spending in El Paso County, Texas - even though the demographics and treatement facilities are roughly equal and the quality of health care is ranked lower in McAllen than in El Paso County.

Basically, Gawande concludes that the situation in McAllen and many areas with extremely high costs is attributable to an "across-the-board overuse of medicine" fueled by a local economic culture that "came to treat patients the way subprime-mortgage lenders treated home buyers: as profit centers."

At the same time, he says, "patients in high-cost areas were actually less likely to receive low-cost preventive services, such as flu and pneumonia vaccines, faced longer waits at doctor and emergency-room visits, and were less likely to have a primary-care physician. They got more of the stuff that cost more, but not more of what they needed."

NEWSWEEK delivers a scathing assessment of much of the health advice delivered on Oprah Winfrey's megapopular talk show. The TV diva's influence is such that she can drive millions of women to pursue better health, but Weston Kosova and Pat Wingert write that "...the truth is, some of what Oprah promotes isn't good, and a lot of the advice her guests dispense on the show is just bad."

"Some of the many experts who cross her stage offer interesting and useful information... Others gush nonsense," they write. "Oprah, who holds up her guests as prophets, can't seem to tell the difference. She has the power to summon the most learned authorities on any subject; who would refuse her? Instead, all too often Oprah winds up putting herself and her trusting audience in the hands of celebrity authors and pop-science artists pitching wonder cures and miracle treatments that are questionable or flat-out wrong, and sometimes dangerous."'

Kosova and Wingert single out for criticism recent appearances on Oprah's show by actress Suzanne Somers to hawk hormone replacement therapy and by Playboy pinup Jenny McCarthy to denounce child vaccines as a cause of autism.

The New York Times didn't mince words in an editorial over the weekend urging Senate passage of a bill giving the FDA the power to regulate tobacco. It declared tobacco manufacturers "a rogue industry," a judgment it said is borne out by a recent court of appeals ruling against those manufacturers.

"The decision makes it clear that the tobacco companies have engaged in deceitful and harmful behavior for many decades and cannot be trusted to reform on their own," the editorial declared. "Regulatory oversight is the best chance to rein them in."

The more than 2,600 YMCAs of the USA are not only the largest not-for-profit community service organizations in the United States; they also are collectively the nation’s largest providers of health and well-being programs, serving 21 million children and adults of all ages, races, faiths, backgrounds, abilities and income levels. The YMCAs have committed themselves to providing community preventive services that encourage healthy lifestyles. In some cases, they've proven an ability to deliver those services effectively at a fraction of the normal cost. On this show, we’re discussing their programs with Katie Clarke Adamson, Director of Health Partnerships and Policy for YMCA of the USA. To listen the podcast, click on the media player below; if you do not see a media player, click here.