Guest blog: Health care perspectives – Rethinking health reform, with a bigger brush

From time to time, we use the OK Policy blog to post submissions we receive from Oklahomans who have interesting perspectives on important policy issues for the state. This entry is from Jeff Alderman, M.D., an associate professor in the Department of Internal Medicine at the University of Oklahoma School of Community Medicine in Tulsa. The opinions stated below are not necessarily the opinions of OK Policy, its staff, or its board. This blog is a venue to help promote the discussion of ideas from various points of view and we invite your comments and contributions. To see our guidelines for blog submissions, click here.

Remember the book It Takes a Village? That was the title of then-first Lady Hillary Clinton’s 1996 work, in which she examines how a child’s well-being can be positively shaped by individuals and groups residing outside of traditional nuclear families.  While the book generally enjoyed good reviews and sales, some found Mrs. Clinton’s approach ‘over simplistic,’ and the issue of the ghostwriter Barbara Feinman became fodder for more than a few anti-Clinton conservatives.

Even though ‘Village’ was published 14 years ago, I think the book makes a strong argument relevant to our situation today. By that I mean meaningful health care reform cannot take place in a silo. To truly improve the health of our nation, we must examine and reshape policies that affect health care behavior, such as education and infrastructure.

To dive deeper into this subject, take a look at the Robert Wood Johnson Foundation’s 2009 report: ‘Commission to Build a Healthier America’.  After surveying more than 174,000 adults, the Commission found that education was a ‘tipping point’ for improving health care outcomes. The more education people had, the more likely they were to report better health, regardless of race or ethnicity. The Commission even posts a ‘State-by State Education and Health Calculator’ on their website. RWJ researchers predicted that if just 12% more Oklahomans attended ‘some college’, 896 unnecessary deaths could be averted.  At the same time, the Commission made many more recommendations, including:

• Create public-private partnerships to open and sustain full-service grocery stores in communities without access to healthful foods.
• Require all schools (K-12) to include time for all children to be physically active every day.
• Ensure that all children have high-quality early developmental support (child care, education and other services).
• Develop a “health impact” rating for housing and infrastructure projects that reflects the projected effects on community health.

That last point about how infrastructure impacts health care is extremely timely. As RWJ was releasing their report, Drexel University researcher Amy Auchincloss, PhD was putting the final touches on her study about neighborhood resources and health outcomes. Reporting in the Archives of Internal Medicine, Dr. Auchincloss and her colleagues found that “people who live in neighborhoods with safe sidewalks, ample parks, good public transportation and ready access to fresh fruits and vegetables are 38 percent less likely to develop diabetes than others” The group examined over 2000 adults in Baltimore, the Bronx and Forsyth County, North Carolina. After two years of study, Dr. Auchincloss concluded “altering our environments so that healthier behaviors and lifestyles can be easily chosen may be one of the key steps in arresting and reversing epidemics, like obesity and Type 2 diabetes.”

To ‘fix’ health care, the president, congress and relevant policymakers need to consider ‘reform’ in broader terms. Comprehensive health care reform must occur simultaneously with other efforts to improve human services – such as education, infrastructure and business development.  Offering products like health insurance exchanges and reducing Medicare waste are steps in the right direction. But to impact real change, we need to raise many standards in our society.  And government cannot fix these problems alone – efforts must come from the community, potentially through public-private partnerships. But no matter what happens, fixing health care in America will take more than sweeping policy changes. It will take a village.