Building a Healthier America

Mark B. McClellan and
Mark B. McClellan Former Brookings Expert, Director, Margolis Center for Health Policy - Duke University
Alice M. Rivlin
Alice Rivlin
Alice M. Rivlin Former Brookings Expert

April 3, 2009

America’s health is failing. Despite unprecedented biomedical achievements, Americans are sicker than they should be and are dying far too young. Shockingly, our children may be the first generation in America to be less healthy and even lead shorter lives than their parents. More than 23 million children, or nearly one in three, are overweight or obese, greatly increasing the odds that they will develop diabetes, heart disease or other disabilities.

Across our nation, preventable diseases and their complications are shortening lives and keeping millions from enjoying life and reaching their full potential at work and in school. Low-income people are especially prone to chronic disease. For example, life expectancy of a resident in Montgomery County, Md., one of the wealthier Washington suburbs, is nine years longer than those living in the urban core.

To improve our health, we believe that reforming our health-care system is essential and urgent. But even if reforms succeed in making a system of high-quality health care available to all Americans, it will fix only a small part of our nation’s health problem.

What we eat and drink, how often we exercise, where we live and work, and how we nurture our children matter much more to health than doctors and hospitals. An estimated 60 percent of early deaths are caused by behavioral, social and environmental influences. In comparison, medical care plays a relatively minor role, preventing only 10 percent to 15 percent of early deaths.

To get large improvements in health, and to address the big gaps in health across neighborhoods and socioeconomic groups, everyone in America must take responsibility for healthy decisions for themselves and their families. This can be difficult for each of us to do, especially when not everyone has the same opportunities to make healthy choices. It is hard to eat a healthy diet when no grocery store sells healthy food near your home, as is common in low-income areas. It’s a challenge to exercise if your neighborhood is unsafe, or if you don’t seem to have time between working, commuting and taking care of the kids.

But it doesn’t have to be that way. The Commission to Build a Healthier America, which we co-chair, found many paths to a healthier future in schools, workplaces and communities all around the country. We documented effective ways to improve health through better nutrition, more exercise, improved community infrastructure and, in particular, enhanced early childhood experiences.

Our children need not grow up unhealthy if we act now. The evidence is compelling — interventions in the early years, when children have the best chance of forming healthy behaviors, can provide the foundation for a lifetime of good health. More than 40 years of research tells us that children who participate in high-quality development programs early in life reap many benefits, including short- and long-term health gains and better academic achievement.

Much can also be done at both the personal and community levels to help people lead healthier lives. In fact, people and programs across the United States have found effective ways to reduce other obstacles to healthy choices.

The Pennsylvania state legislature, responding to the need for more supermarkets in underserved communities, created the Fresh Food Financing Initiative. The state committed $30 million over three years, and each public dollar was leveraged with three private dollars. The outcomes have been impressive. Thus far, $58 million in spending on 69 projects in 27 counties has not only made following a healthy diet much easier; these public-private initiatives have created or retained 3,900 jobs.

A national non-profit based in Colorado is also helping people improve their health and quality of life through simple and inexpensive Web-based tools that can be applied at home or in schools, workplaces or entire communities. Since 2003, America on the Move has helped 30 million people make positive changes toward healthier lifestyles — showing us that even small changes in eating habits and physical activity can put people on a path to better health.

Programs like these that work have similar characteristics: collaboration, leadership, local adaptability, accountability and continuity in funding. Since there is no one-size-fits-all solution, proven successes must be shared among similar communities, workplaces, schools and families. Public and private leadership is required to implement these proven pathways to better health.

From the standpoint of our economy, our future and our families, the need to improve our health is greater than ever, and the evidence on how to do it is clear. It is time to build a healthier America.