Have we lost sight of the overall goal of health care reform -- improving people's health -- by focusing too narrowly on coverage? That's a question I found myself asking last week while attending the Grantmakers in Health annual meeting on health philanthropy in Orlando (where the weather was as cold and dreary as back home in New York).
The closing speaker was Dr. Christopher Murray, a physician and health economist based in Washington State, who showed us slide after slide on the geographic variation in health outcomes and mortality within the United States. He pointed out that, although the United States as a whole ranks about 36th in the world in life expectancy, in many counties across the country, the average life expectancy is equal to that in China or Iraq -- countries in the middle or bottom of the list.
New research supported by the Robert Wood Johnson Foundation, which ranked the overall health of every county in New York (and in all 50 states), also bears this out. For example, 27% of people in the Bronx are in poor or fair health, while in Putnam County it's only 9%.
Murray argued that expanding health insurance is one way to improve health outcomes and reduce mortality, and the national health reform discussion has focused on expanding health insurance coverage and reining in health care costs. But even universal coverage wouldn't eliminate disparities entirely or get our nation's overall life expectancy much closer to Japan's (which was number one on the list), because our health is about more than just the care we receive.
How healthy we are also has to do with whether we smoke, what we eat, and how much we exercise. For example, expanding insurance coverage to everyone in the United States would save between 20,000 and 40,000 lives per year, but ending obesity would save 216,000 lives annually.
While we must take responsibility for our own health, it's not just about the choices we make as individuals. Policy choices also play a major role, from whether healthy, affordable food options are available in our neighborhoods, to whether we have safe places to walk, play, and exercise in our communities. When we tackle those issues, we will see a significant increase in the health of all of our communities, and fewer disparities across counties.
Here in New York, could public/private partnerships to bring supermarkets to underserved areas improve the health of families who have limited access to affordable, nutritious foods, as it has in Pennsylvania?
Could the proposed soda tax reduce New Yorkers' consumption of high-calorie, low-nutrient beverages, just as tobacco taxes and smoke-free indoor air policies have reduced tobacco use?
Would investments in complete streets policies (which ensure that our roads work not just for drivers, but also for pedestrians and bicyclists) improve our health and wellbeing by allowing us to move more -- and more safely -- in cities and towns throughout the State?
Could enforcement of school wellness policies ensure that all kids get nutritious foods and ample opportunities for physical activity during the day?
I would argue that the answer to all of these questions is yes, and that these types of State- and community-level interventions could help to improve the health of all New Yorkers, particularly those who now are struggling the most.
So have we lost our focus on improving people's health by focusing on coverage? If we stop pursuing broader reforms to improve health once the federal health care bill passes, then yes. But if solving the coverage problem federally allows states to focus on other aspects of improving health, then we've been on the right path all along.