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Policy Change Is Key If We Want to Reduce Preventable Deaths

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A study just released by the Centers for Disease Control and Prevention (CDC) found that 200,000 Americans die prematurely from heart disease and stroke each year. Every three minutes, someone's spouse or parent or child dies in a way that experts say is avoidable. More than half of these deaths are in people under 65.

Sixteen years ago, I founded Prevention Institute, an Oakland-based nonprofit dedicated to advancing policies and strategies that improve community health. In those years, I've seen prevention evolve from a fringe notion to an idea championed by communities across the country. This latest report from the CDC shows how far we still have to go -- and suggests some strategies for how we might get there.

We've known for a long time that the biggest factors influencing our health are the environments that shape our communities. Reducing preventable deaths, as well as illness and injuries, requires a comprehensive approach aimed at changing our communities and policies, not just modifying individual behaviors.

Just look at the prevention successes of the past: We reduced smoking, cut injuries and deaths from car crashes, and drastically lowered lead poisoning when we pursued policies and passed legislation that regulated industries and business and transformed conditions and environments, instead of simply telling individuals to change their behavior.

The CDC report comes at a time of mounting political pressure to back away from efforts to create policy change and to focus instead on individual responsibility. It also reminds us of something we don't always like to admit: that health, like wealth, is not spread equally across this country. People living in poor states and counties have double the rate of preventable death from heart disease as those who live in wealthier areas. African-Americans are twice as likely as whites, and men more than twice as likely as women, to die from preventable cardiovascular disease.

These kinds of health disparities are not simple accidents of genetics or geography. There are, in essence, two Americas -- one with easier access to conditions that lead to good health, the other struggling to survive amidst an ocean of social problems that make healthy living a daunting quest.

If we want to improve health and prevent premature deaths, we need to make sure that all communities have well-maintained parks where children can play, as well as sidewalks and bike paths so children can safely walk or ride their bikes to school. Streets must be safe so people aren't afraid to take an evening walk. Every neighborhood needs grocery stores and farmer's markets so busy parents can buy what they need to make healthful meals for their families.

It's unacceptable that 200,000 Americans die prematurely from heart disease and that death and illness come most often to the most marginalized among us. If we really want to live in a country where everyone has a fair chance at a healthy life, we need to pursue policies that change conditions in our communities and invest in the infrastructure for health.

Fortunately, many programs are doing just that. This year, Los Angeles approved a healthy design ordinance that amended the county's planning code to promote walking, bicycling and improved access to healthy foods. Mobile farmers' markets are delivering farm-fresh produce to communities in Stockton, the San Joaquin Valley, and Santa Barbara County. County health departments in the Bay Area and Los Angeles have sponsored "soda-free summer" campaigns aimed at getting young people off sugary drinks. Walking clubs have popped up in scores of cities, organized by YMCAs, senior centers, and other groups.

These are exactly the kinds of efforts that can make our communities healthier. Many of them have received grants from the Prevention and Public Health Fund, a program set up by the Affordable Care Act. For the first time in U.S. history, the Act set up a dedicated fund to support efforts to prevent illness and injury, and the Fund has awarded some $285 million to communities across the country. Despite its success, it has been a constant target of Washington budget-cutters. The Fund must be maintained and strengthened, not cut or eliminated, as some in Congress wish to do.

We have answers. We know what works. Preventable deaths can be prevented and people can live healthier lives. If we want a healthier America, we need to invest in prevention.

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