Health. It's not just one thing. It's a lot of things.

--by Jim Marks

As a person who trained and practiced as a pediatrician, several careers ago, I am never going to dump on the importance of getting good health care.  It is my fondest hope that health care reform can happen so that everyone can get the health care they need.  But at the same time, the course of my life has taught me that there are so many other things that determine how healthy a person is--and that overall, we Americans are not doing so well.

This week, RWJF released a report about all of those other things.  This report comes out of a commission that we created to look at the factors that affect Americans' health in our homes, our work environments, and communities.  In wonky terms, we call these factors "social determinants."  In plain English, the commission's purpose was to look for ways beyond medical care that could improve health. 

What do we mean by, beyond medical care?  There is a ton of evidence that shows where and how people live, where they go to school, how we go about the daily business of our lives--all of that has an effect on our health.  And overall, these effects are HUGE.  And the thing is, we tend to frame the daily business of living, and how it affects our health, solely as a matter of personal choice and personal responsibility.

Personal choice does play a role in my health and everyone's health.  I can decide, for example, to have a bowl of ice cream for dessert instead of fruit.  People can make choices about being physically active and avoiding risks like smoking.

But at the same time, many of us have fewer choices than others.  If it's already hard to say no to the bowl of ice cream or the cheeseburger, how much harder is it if there's no grocery store with good produce or farmers' market in your area?  If it's already hard to help your kids stay away from junk food, how much harder is it when schools are serving them unhealthy food and snacks--in effect teaching them that this is what they should eat?

Today's report from the commission comes with a set of recommendations for policy-makers to consider as we create initiatives and programs to help us get healthy, and stay healthy.  It is particularly focused on children, so we can get a jump-start on helping them and their families, so children everywhere can grow up healthy.  We know that no set of government programs can drive all of the choices facing parents and families, but government is supposed to help make these choices easier by reducing the barriers to good health.

The commission is asking for some big things.  It is asking for employers and school leaders to step up.  It is asking for federal and state and local leaders to create policies and programs directly aimed at improving health. It also says that before we do anything big in other parts of our society, like agriculture or education or housing--let's first make sure we know what the effects would be on people's health. 

Take a look.  Think about what they are asking for and how it relates to you, or people you know.  Think about how these recommendations could help improve the health and livability of your community--and the health and livability of communities across America.  As we consider health reform in 2009, let's think about the neighborhoods and towns in which we all live, and ask ourselves:  how can health reform change these places and make them healthy places to live?

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Update for the blog readers:  he's everywhere!  Check out Jim's Huffington blog post on the same topic here.