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Bearing the Burden: Global, State and County Evidence to Advance U.S. Health

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Co-authored by Derek Yach, Executive Director, Vitality Institute & William Rosenzweig, Vitality Institute Commission Chair and Managing Partner, Physic Ventures LP

Recent evidence suggests startling differences in chronic disease risk factors amenable to prevention at the international, state and county levels in the United States. The following article, showcasing obesity as a supporting example, applies to common risk factors including tobacco use and alcohol abuse that underpin the growing burden of disease and escalating health care costs.

While the U.S. invests substantially in health compared to peer nations, it continues to perform poorly on international health measures, metrics and indices. The National Research Council and Institute of Medicine in 2013 places the U.S. last in average body mass index (BMI) for individuals between 25 and 44 years of age when compared to 17 countries. Similarly, the Human Capital Report 2013 published by Mercer and the World Economic Forum ranked the U.S. 43rd in health and wellness, and 112 out of 122 countries in obesity (defined as the percent of adults with BMI greater than or equal to 30). Analysis of these reports attributes the U.S.'s meager performance in health to underinvestment in health prevention and promotion as well as deeper issues in American values founded upon devaluing health yet overvaluing individual choice and consumer power.

Although overhauling the entire U.S. health system is a substantial challenge, ensuring the best health currently achieved in the U.S. becomes the norm is possible and desirable. At the state level, America's Health Ranking Report indicates that Colorado, Massachusetts and Hawaii have the lowest, and Louisiana, Mississippi and Arkansas have the highest, percentage of adults suffering from obesity. Furthermore, states opting out of Medicaid expansion under the Affordable Care Act witness poorer health outcomes when compared to those expanding Medicaid. (1) As a consequence, states most needing preventative services obtain them the least. Implementing successful health promotion strategies found in healthy states is feasible in other poor performing states through relatively high impact, low-cost interventions introduced in the workplace.

Finally, county analysis highlights the strength of local organizations in promoting health, as employers are often county based and source employees locally. The Institute for Health Metrics and Evaluation at the University of Washington developed graphic maps to depict obesity and physical activity at the county level. These maps suggest that it is in employers' best interests to promote public and private efforts that support actions to improve community health.

On January 7, 2014, the Vitality Institute in partnership with the Denver Metro Chamber of Commerce hosted a Commission Forum titled "Building Healthier Societies: Fostering Healthy Workplaces" in Denver, Colorado. The Commission Forum was the second in a series taking place across the U.S. during Spring 2014 to organize a collective voice of prevention in the context of the Institute's Commission on Health Promotion and the Prevention of Chronic Disease in Working Age Americans. The Commission aims to place the power of evidence-based prevention at the center of health care policies and actions in the U.S. Commission findings and recommendations will be available in May, 2014.

How does your workplace promote health? We want to hear from you! Join the conversation @VitalityInst or view the webcast of the Commission Forum here: http://www.liveeventstream.com/vitalityforumdenver/.

References:
1. Pomeranz, J., 2014. The Affordable Care Act's coverage of adult clinical preventive health services (forthcoming).