What did the Robert Wood Johnson Foundation hope to accomplish through the Commission to Build a Healthier America?
The Foundation created this national, independent and nonpartisan Commission to raise awareness of the factors beyond medical care that affect a person’s health and recommend viable short- and long-term strategies to help improve the health of all Americans.
Who were the Commissioners?
This national, independent and nonpartisan health Commission represented a diverse group of innovators and experts with the ability to cross traditional boundaries, mobilize partners to action, and identify practical, timely solutions. The Commission Co-Chairs were Mark B. McClellan, Director of the Engelberg Center for Health Care Reform and Senior Fellow, Economic Studies at the Brookings Institution and Alice M. Rivlin, Senior Fellow, Economic Studies Program at the Brookings Institution and Director of the Greater Washington Research Program. See the full list of Commissioners.
What did the Commission learn as a result of its work?
Where we live, learn, work and play has a greater impact on how long and well we live than medical care. A person’s health is greatly influenced by powerful social factors such as education, income, housing and neighborhoods.
America spends more on health care than any other nation, yet Americans are not the healthiest people in the world. In life expectancy and infant mortality, the United States ranks near the bottom in comparison with other industrialized nations.
For the first time, we are raising a generation of children who may live sicker and shorter lives than their parents.
Health reform is essential, but improving the health of all Americans requires broadening our view beyond medical care. We must find ways to enable more people to lead healthy lives and avoid getting sick in the first place.
A healthier America depends on each of us taking responsibility for our own health and making healthy decisions such as healthy eating, being physically active and avoiding risks like smoking.
But not everyone in America has the same opportunities to make healthy choices. Sometimes barriers to health are too high for any one person to overcome. It’s hard to eat a healthy diet if there is no grocery store selling healthy food in your neighborhood. It’s a challenge to be physically active if your neighborhood has no sidewalks or is unsafe.
Good health requires people to make responsible personal choices and requires a societal commitment to remove the obstacles preventing too many Americans from making healthy decisions.
Building a healthier nation will require substantial collaboration among leaders across all sectors, including leaders in child care, education, housing, urban planning and transportation – leaders who may not fully comprehend the importance of their roles in improving health.
Don’t Americans have the best overall health in the world?
We should be one of the healthiest countries in the world, but we are not. The U.S. continues to rank near or at the bottom in comparison with all industrialized (higher-income) countries, even ranking below a number of less affluent nations. People in 22 countries (including Spain, Canada and Greece) live longer on average than Americans. Babies born in the U.S. are more likely to die before reaching their first birthdays than babies in Canada, the Czech Republic, Greece and more than 20 other countries.
What affects a person's health?
Where we live, learn, work and play has a greater impact on how long and how well we live than medical care. Although medical care is essential for relieving suffering and curing illness, only an estimated 10 to 15 percent of preventable mortality has been attributed to medical care. A person’s health and likelihood of becoming sick and dying prematurely are greatly influenced by powerful social factors such as education and income and the quality of neighborhood environments.
It sounds like much of the problem is related to poverty and income. Did the Commission look at solving the problem of poverty?
There is no question that poor health and poverty are inter-related, but this Commission did not focus on addressing poverty in America. This Commission is committed to providing better health opportunities for Americans in every community to grow up and stay healthy. The Commission sought answers to questions that impact all of us – including but not limited to those living in poverty.
Hasn’t this work already been done?
The Foundation invested in this initiative because there was, and still is, a strong need to look beyond the medical care system for ways to improve health. During the life of the Commission, there was significant research in Western Europe on socioeconomic factors that affect health, but little research in the U.S. that addressed how non-medical factors affect health, and policy attention had been largely focused on disparities in medical care and health insurance coverage. The Commissioners represented diverse expertise related to the broad range of factors that impact health. Given this expertise, the Commission had the ability to look beyond the medical care system for ways to improve health.
What made the Commission's work necessary and timely?
Despite enormous investment, America was not, and still is not, achieving its full health potential. During the life of the Commission, we saw an intense period of debate not just among policy makers, but all Americans across the country, about health reform and the future of health care in America. The Robert Wood Johnson Foundation Commission to Build a Healthier America aimed to broaden the debate to focus on changes the country can make outside of health care to improve the health of all Americans, knowing that the country’s historical path of increasing medical spending without decreasing disease in America was unsustainable. We knew that we must find ways to empower more people to make healthy decisions and avoid getting sick in the first place.
What is different as a result of the Commission?
When the Commission formed in February 2008, health reform discussions focused on health care costs, access to physicians and insurance coverage. Since the Commission issued its recommendations in April of 2009, the very definitions of what affect health have broadened. People talk about improving school lunches, building sidewalks and bike lanes, leveraging education, environment and better housing to improve health, and consider health in all policies.
What did the Commission accomplish?
At the close of the Commission in December 2009, we started to see those involved in health reform and leaders from all sectors begin to understand and embrace the message that there is more to health than health care – and that the country needs to focus on preventing people from getting sick in the first place.
The Commission documented the evidence surrounding how social factors affect health. It made clear the links between education and health, housing and health, environment and health and transportation and health. It provided a blueprint for how people can turn their concerns about the impact of social factors on health into action. Some key changes included:
- Legislation supporting changes in nutrition
- White House meetings calling for healthy food in schools and making fresh food available to all
- Cities examining how to bring grocery stores to poor neighborhoods
- Programs aimed at improving physical activity
- Foundations beginning to change their grantmaking to address the social factors that affect health
- Federal agencies joining together to create livable communities
Are there examples of the Commission's recommendations being implemented?
At the close of the Commission, there were several examples
of different sectors taking up the charge of the Commission and implementing
- The President’s Council of Economic Advisers’ Report on Health Care cited the
Commission’s research showing the importance of social factors on health –
health care expenditures are not the only factors that can affect how long and
how well people live.
- HHS Secretary Katherine Sebelius announced $650 million in funds for a community
prevention and wellness initiative. The funds will be used to increase physical
activity, promote nutrition, decrease obesity and decrease smoking in U.S.
communities. These are all recommendations of the Commission.
- The Surgeon General issued a call to action to promote healthy homes with an
accompanying strategic plan from HUD that describes the necessary steps to
achieve healthier housing. In introducing the initiative, HHS Secretary
Katherine Sebelius said that healthy homes can lead to healthier lives.
- DOT, HUD and EPA launched a collaboration to create healthier, more livable cities.
The interagency partnership will coordinate federal transportation,
environmental protection and housing investments to make neighborhoods safer,
healthier and more vibrant.
- Programs, such as the Fresh Food Financing Initiative in Philadelphia, where grocery stores are
brought into poor neighborhoods to provide access to fresh food, are being
taken to scale and implemented in other cities.
- The Early Learning Challenge Fund, a federal initiative that is making its way
through Congress, would provide $8 billion to states to raise the quality of
early education programs for children from birth to age five.
- Legislation signed by President Obama granted the Food and Drug Administration sweeping authority
to regulate the manufacturing, marketing and sale of tobacco products – the
leading cause of preventable death in the U.S. CBO estimates that youth smoking
will fall by 11 percent during the next decade.
Will the Commission's work and recommendations live on after the official close of the Commission?
Yes, much has been accomplished, but there is still much to
do to achieve improvements in the health of all Americans. Although the
official work of the Commission ended in December 2009, The Robert Wood Johnson
Foundation is integrating the work and findings of the Commission into all its
programming addressing the social determinants of health. Commissioners will
continue to serve as ambassadors to their communities at large, seeking real
change in how communities, neighbors and agencies approach health. Government
agencies, schools, nonprofit organizations and municipalities will explore how
to integrate health into all policies. And, the Commission’s Web site will
continue to be available as a resource, with new follow-up work available at