Co-authored by Anita Verma, Marisa Dowling, Julia Liebner, and Kate Pitts
As the new decade begins, America's health care system is in crisis. In 2009, spending on health care in the United States was 17.3% of GDP, far exceeding that of any other industrialized nation. Yet despite these expenditures, the United States ranks only 49th on life expectancy and 37th in the health status of its citizens worldwide. Nearly one out of every two American adults suffers from at least one chronic illness. Two out three adults are overweight or obese, one out of five Americans smoke, and 38% of all deaths in America are attributable to four modifiable health behaviors, including tobacco use, physical inactivity, diet, and alcohol consumption. Moreover, the United States does not have a robust, integrated system in place to evaluate the quality and outcomes of health care services delivered. With studies finding that patients in the United States receive the recommended care only 55% of the time and that an estimated 30% of national expenditures are wasted on the overuse, underuse, and misuse of medical and administrative services, the message is clear: Americans are spending far too much on health care for far too little health in return.
The currently troubled landscape for health in the United States underscores why the effective implementation of innovative health reform measures is urgently needed to revitalize our nation's health care system. In this new decade, achieving a healthy America involves more than having health insurance and access to medical services. Rather, the United States must engage in a comprehensive approach in which health is put back into the health care system.
To achieve this goal, some critical resolutions are needed. Quality and value must be the cornerstones of health care reform implementation. Additionally, a healthy America requires strengthening the public health infrastructure to underscore the power of prevention and community health, promote global health and health diplomacy, and secure sustained funding for scientific and medical research. In this national effort, individuals, businesses, health care providers, and all sectors of government and society have significant roles to play in advancing health in the United States.
Listed below are some key steps for achieving healthier people, a healthier nation, and a healthier world in 2010 and beyond.
Resolutions for Healthy People
Good health is the foundation for a productive life. Individuals must take personal responsibility to adopt healthy behaviors, become educated health consumers, and actively engage with their health care providers and in their communities to improve their health.
1) Prioritize Prevention and Chronic Disease Management
To reduce the toll of chronic disease in America and to achieve long and healthy lives, individuals must adopt healthy behaviors. Nearly two out of five deaths annually in the United States are linked to four modifiable behavioral risk factors. Therefore, a recipe for a healthier life means eating a nutritious diet, maintaining a healthy weight, being physically active, not smoking, and moderation in alcohol use. Individuals must also obtain routine clinical check-ups and screening exams to reduce their risk of disease and disability as well as find disease when there is the best chance for cure. According to the National Commission on Prevention Priorities (NCPP), 100,000 lives could be saved annually by increasing the use of five preventive services: low-dose daily aspirin to prevent heart disease for at-risk individuals, access to smoking prevention and cessation services, influenza and other vaccinations, and screening for colorectal and breast cancer. Individuals should gather information about their family health history and learn the symptoms of diseases for which they are vulnerable. By adopting a healthy lifestyle and getting lifesaving screening exams, both personal and national health can be significantly improved.
Resolutions for a Healthy Nation
All Americans have the right to live in healthy and safe communities, have access to high-quality care, and be protected from financial hardship due to medical expenses. Current health care reform efforts will be considered successful if federal policies can achieve these goals while also bending down the cost curve. However, these goals cannot be realized through fragmented investments and reforms. A 21st century strategy for re-engineering the health system in the United States must harness the power of all sectors of society in partnership with the American people.
2) Establish Health in All Policies
Improving health in America is not merely the province of the health sector. There are over 40 federal agencies whose policies affect health, including the U.S. Departments of Health and Human Services (HHS), Agriculture (USDA), Transportation (DOT), Housing and Urban Development (HUD), Defense (DOD), Environmental (EPA) among others. The mobilization and coordination of all agencies of Federal, state, and local governments is critical to ensure sound policies in agriculture, transportation, and the environment, among other sectors, in order to foster healthier American lifestyles and communities.
3) Emphasize value and quality in health care reform and comparative effectiveness research
The current health care system suffers from a fundamental misalignment of incentives rewarding the delivery of treatments and conducting procedures and tests rather than preventive interventions. This results in higher costs and inefficiencies in the system without clear improvements in health outcomes for patients. To remedy this systemic failure, value must become the cornerstone of a re-designed system to improve quality, minimize waste, and lower costs. Investing in comparative effectiveness and delivery system research that documents findings is needed to develop new metrics of success based on patient outcomes and waste reduction. Comparative effectiveness research (CER) at a national level will assist in evaluating the quality of care that is delivered. Experts estimate that 30-50% of current American health expenditures are wasted on overuse, underuse, and misuse of medical and administrative services. The goal of CER is to evaluate the effectiveness of interventions in the prevention, diagnosis, treatment, and monitoring of health conditions and disease, as well as in the health care delivery system, to determine what works and for whom. CER's "value" outcomes measured should include survival, functional improvement, and medication and device side effects, as well as a variety of condition-specific and health delivery outcomes.
4) Embrace information technology nationwide to advance health care
Health care providers must adopt known quality-enhancing measures, a health information technology (HIT) to reduce costs and medical errors. HIT will facilitate effective coordination of care, improved clinical decision-making at the point of care, reporting of health outcomes, and the integration of prevention programs. Every American should have an integrated electronic health record (EHR) that will allow for interoperability, privacy protections, and results judged by well-designed outcome measures. Integration of nationwide EHRs will facilitate population-wide studies, more personalized medicine, and decrease the possibility of medical errors as well as reduce waste caused by duplication of interventions.
5) Strengthen the public health infrastructure to make community health a top priority
An effective health care system must do more than just treat disease. It requires the capacity to promote good health across the lifespan. Today, preventable chronic diseases account for more than 75% of health care costs. Yet, the U.S. spends only 3-5% of its total health expenditures on prevention. Successful implementation of public health initiatives requires the support of a politically and structurally re-engineered health care infrastructure that recognizes and rewards the economic and societal value of prevention. To begin the transformation of the current "sick-care" system operating on a disease treatment model, sustained investments in prevention are needed across all sectors of society, business, and government to help reduce disability and premature mortality within communities as well as to promote a culture of wellness.
Specific programs and policies to prevent tobacco use and obesity are required, including educational campaigns that promote awareness and action. It is unacceptable that rates of severe childhood and adolescent obesity have tripled over the past 25 years, and that 17% of youth are now overweight, and 20% of high school aged children smoke. If current obesity trends continue, it is predicted that 43% of American adults will be obese by 2018. Chronic diseases linked to tobacco use and obesity are the primary drivers of healthcare costs in America and are compromising national health security and the sustainability of the U.S. health care system. Enacting federal, state and community policies that underscore the power of disease prevention are essential to ensure a healthier future for the American people. Otherwise, this generation of children may be the first who are not as healthy, or live as long, as their parents. Furthermore, the costs of care will significantly damage our nation's economy, national security, and future.
6) Invest in health research and the career development of scientists
Research serves as the backbone for all components of a 21st-century health care system, providing the foundation for improving public health, accelerating the development of diagnostics and new treatments, advancing health care delivery, and promoting global health. However, the amount of funding for biomedical and public health research in the United States has been erratic in recent years. The cornerstone to accelerating the development and delivery of new medical advances and securing America's competitiveness in the 21st century lies in sustaining investments in scientific research and human capital. In the years ahead, a sustained national funding stream of health appropriations above the $10 billion provided in the federal stimulus for the National Institutes of Health (NIH) must be provided. Investments in basic and applied science, behavioral, health care delivery, comparative effectiveness, and translational research are needed to build a more effective, efficient, and equitable healthcare system. In order to remain competitive in an increasingly technology-driven global economy, reforms are needed in the US educational system from primary school through post-doctoral training to produce and retain more new scientists and engineers who will drive high-impact, innovative research in America.
Resolutions for a Healthy World
Our common humanity compels, and our national security requires, that global health be a critical priority for the U.S. government. Both industrialized and developing nations face the double jeopardy of both infectious and chronic illness epidemics including AIDS, heart disease, cancers and the threat of a pandemic flu. While one out of four deaths worldwide is due to infectious diseases, chronic illnesses now account for nearly 50% of all deaths and disability in low- and middle-income countries (LMICs). Investing in global health can serve as a "smart" tool of foreign policy building a world with more friends and fewer enemies and strengthening all nations' ability to ensure a healthier future for its people.
7) Establish a comprehensive national strategy for global health
In the 21st century, America's health is global health, and global health is America's health. As a central pillar of foreign policy and public diplomacy, the Administration's Global Health Initiative should establish an integrated strategy for global development and health assistance, with a focus on health systems strengthening to ensure sustainability. Such a strategy should build on the foundation of advances made by PEPFAR, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the President's Malaria Initiative, among others. This National Strategy should be able to address diseases including AIDS, malaria, tuberculosis, maternal and child health as well as emerging needs in global health 10-15 years from now. It should also establish a roadmap for collaboration across federal agencies, the public and private sectors, and with a broad range of partners both domestically and worldwide.
8) Develop an integrated U.S. global health policy architecture and inter-agency collaborative framework for advancing global health
Our nation requires a new Federal global health vision and architecture, evidence-based policies, and an intensified commitment to improve global health as a strategic and value-driven goal for U.S. foreign policy. It is critical to address both the obstacles and opportunities for progress in global health, with particular emphasis on (1) the U.S. federal government architecture for promoting and financing global health initiatives; (2) a revitalization of the U.S. Agency for International Development (USAID) as the government's leading international development agency; (3) using health diplomacy as a foreign policy tool; (4) emphasizing health systems strengthening in low- and middle-income countries (LMICs), and (5) measuring and evaluating the impact and effectiveness of U.S. foreign health assistance.
The solutions to the health challenges we face as individuals, a nation, and world lie with the talent, imagination, innovation, and commitment of the American people. Now is the time for individuals, families, schools, businesses, foundations and government to work together to move our nation and world toward a healthier and more prosperous future. The passage of health reform legislation is one important component of this transformation process. To write a prescription for a healthier future, we as individuals, a nation, and global community must commit to making and keeping resolutions that emphasize a comprehensive, innovative approach to improving health in this new decade and beyond.
Rear Admiral Susan Blumenthal, M.D. (ret.) is the Director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress in Washington, D.C., a Clinical Professor at Georgetown and Tufts University Schools of Medicine, and Chair of the Global Health Program at the Meridian International Center.
Anita Verma, a recent graduate of Stanford University, is the Special Assistant to Dr. Blumenthal and a Research Associate at the Center for the Study of the Presidency and Congress in Washington DC.
Marisa Dowling, a recent graduate of Stanford University, was a Health Policy Fellow at the Center for the Study of the Presidency and Congress in Washington DC.
Julia Liebner, a recent graduate of Stanford University, was a Health Policy Fellow at the Center for the Study of the Presidency and Congress in Washington DC.
Kate Pitts, a Master of Public Health candidate at George Washington University, is a Health Policy Fellow at the Center for the Study of the Presidency and Congress in Washington DC.