Friday, February 19, 2016

Poorer health, shorter lives

An editorial in the American Journal of Public Health laid out the problem facing the US: We spend the most on "health care" but the least of social services. In return, the health of the nation is failing compared to other developed nations.  In fact, we are losing ground.  The editorial is concerned that this deep problem is non-issue on this year's campaign trail.  I believe that part of the problem that we're in is a linguistic tangle, because we use "health" as a synonym for "disease."  What doctors do is called "health" care but it is actually "disease" care.  You can't actually get to "health" by spending endless amount on "disease."  To get to health, you actually have to spend on the things that create health, like housing people can afford, jobs with decent pay, and education that prepares for the workplace without bankrupting people.

County Health Rankings Model
The Robert Wood Johnson Foundation, aware of this larger picture, has launched a "culture of health" project.  An Orange NJ coalition, led by the Board of Education, has been funded to develop a culture of health project.  The RWFJ program begins with the County Health Rankings model of contributors to health, which allocates the proportion of contribution made to health by a list of factors.  Social and economic factors, for example, account for 40% of the influence on health, while clinical care ("disease management") accounts for 20%.  This model suggests that as we widen our lens we will open up ways to spend that both "manage disease" and "create health."

The Healthy Orange Coalition has focused on educational attainment, because that creates a clear pathway to health.  In fact, increasing educational attainment will improve many other markers, like employment, income, health behaviors, increasing the effect of this single intervention to many areas.  The Coalition is in the early phases of developing a broad network of support which can guide the campaign.  More to come!