A Healthier America: Moving from Sick Care to Health Care in the Next Four Years

February 14, 2013
by Laura Segal
Altarum Health Policy Forum

More than half of Americans are living with one or more serious chronic diseases—ranging from type 2 diabetes to cancer—even though a majority of these diseases could have been prevented. 

But, there has never been a strong national focus on preventing disease and improving health, which is the most effective, common-sense way to reduce health care costs. As a result, America’s health faces two possible futures:

1. The Status Quo: We continue down our current track, consigning millions of Americans to health problems that could have been avoided;OR
2. A Healthier America: We invest in giving Americans the opportunity to be healthier while saving billions of dollars in health care costs and improving productivity.

Research has shown that prevention delivers real value as a cost-effective way to keep Americans healthy and improve quality of life—everyone wins when we prevent disease rather than waiting for people to get sick and treating them then. With track two, health care costs will go down, neighborhoods will be healthier and provide more economic opportunity, and people will live longer, healthier, and happier lives.

On January 29, 2013, the Trust for America's Health released A Healthier America 2013: Strategies to Move from Sick Care to Health Care in Four Years, which provides high-impact recommendations to prioritize prevention and improve the health of Americans, and, in so doing, would switch the nation’s course to track two.

Advance the Nation’s Public Health System

America’s public health system is uniquely  designed to (1) diagnose the biggest, most expensive health problems in a community; (2) identify the most effective strategies to improve health and lower disease rates; and (3) partner with members of the community, health care providers, a range of government agencies, and the private sector to deliver results. Federal, state and local health departments need to adapt in response to the changing health care system, technology and priorities, and focus on those activities that they are uniquely qualified or positioned to carry out, and that they can perform most efficiently. Accomplishing this will require:

• Adopting a set of “foundational” capabilities, such as those defined by the Institute of Medicine (IOM) and Transforming Public Health projects;
• Restructuring federal public health programs to better prioritize and coordinate prevention policies, so that agencies perform their functions most effectively and efficiently, such as by realigning direct services and program management, and improving support for state and local health departments so that they are able to meet their core capabilities; and
• Ensuring sufficient, sustained funding that includes a mandate to demonstrate the ability to meet foundational capabilities in exchange for greater flexibility.

Build Partnerships Within and Outside the Health Field

Public health departments play a central role as chief health strategists for communities but cannot reach goals to improve their community’s health on their own. To be effective in improving health in neighborhoods, workplaces and schools, strategies must involve a series of common-sense partnerships, including:

• Partnering with health care payers and providers to support preventive services at the doctor’s office and to give individuals the opportunity to take care of themselves and their families outside the doctor’s office. Prevention must be a high priority and fully integrated into how health care system models are reformed and financed. Accomplishing this will require:
  • Ensuring that insurance providers reimburse for effective prevention approaches both inside and outside the doctor’s office;
  • Integrating community-based strategies into new health care models, such as by expanding Accountable Care Organizations into Accountable Care Communities or including public health in global health budget formulations, bringing together partners across sectors to provide a continuum of support for better health both inside and outside the doctor’s office; and
  • Working with nonprofit hospitals to identify the most effective ways they can expand support for prevention through community benefit programs.

• Partnering with sectors beyond the health system by working with education, transportation, housing and other areas to put common-sense measures into place that improve health while also supporting other goals. Where Americans live, learn, work, and play have a major impact on health, and the public health system can work with other sectors to identify the most pervasive, highest-cost problems in their local communities, and develop win-win strategies to achieve mutually beneficial results. Accomplishing this will require:
  • Fully supporting the Prevention and Public Health Fund and expanding the Community Transformation Grant program to support local communities in bringing together a range of partners to address top health concerns, using proven, evidence-based approaches;
  • Implementing the recommendations for each of the 17 agency partners in the National Prevention Strategy; and
  • Encouraging all employers to provide effective, evidence-based workplace wellness programs.

Today’s children could be on track to be the first in U.S. history to live shorter, less healthy lives than their parents—that doesn’t have to be the case and it won’t be if we take track two.

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