The Users' Guide to the Health Reform Galaxy

Recess for better health

Jim Marks, senior vice president and director of the Health Group, encourages us to turn to the playgrounds to build prevention efforts and reclaim recess to help improve children’s learning and well-being. This post first appeared on The Huffington Post. As another way to improve children’s health, read Jim Marks’ thoughts about the importance of attacking “cereal killers” in the grocery store to help reverse childhood obesity here.
 
When it comes to improving the health of Americans, we normally talk about what happens in a doctor's office.

And when it comes to improving education, we usually focus on what happens in the classroom.

But what if we looked outside of the classroom and the doctor's office? In fact, what if we just looked outside?

It turns out that there's one place you can go to improve learning and health at the same time: the elementary school playground. A growing body of research suggests that playing games like kickball or four square at recess may be the secret to a successful school day and building a lifetime of health.

Kids today are getting fewer and fewer minutes on the playground for recess -- the average is now down to about 22 minutes each day. Facing pressure to meet academic and other requirements, many schools have cut back on recess and some have eliminated it entirely, thinking that this can help them with their academic mission.

However, this trend toward sacrificing recess may produce the exact opposite result and hurt academic performance. In fact, according to a new Gallup poll of elementary school principals, the vast majority surveyed linked having recess to academic achievement, and two-thirds reported that students listen better and are more focused in the classroom after they have had recess. Principals also overwhelmingly saw recess as key to their students' social development.

Obama's Budget Includes Modest Increases for Public Health and Prevention

Jeffrey Levi, executive director of Trust for America's Health, writes about advancing the agenda of prevention and public health in tough economic times.

In a time of very tight financial constraints, we all need to be realistic about our expectations. In the context of a freeze on overall domestic non-defense/security discretionary spending, the Obama Administration did show its commitment to a strong public health system that focuses on prevention. Obviously, we'd love to see big increases for public health; however, this budget, combined with large investments about to be released under the American Recovery and Reinvestment Act (ARRA), will significantly increase the capacity of communities to respond to pressing prevention needs.

But the question of health reform still looms large. Unless we take action to improve the health of Americans, we'll lose an important opportunity to rein in health spending. Treating chronic diseases is
one of the biggest drivers of health care costs,  and until we focus more on prevention in a sustained and comprehensive way, we're never going to get these costs under control.

Prevention - An Impetus for Moving Health Reform Forward

Jeffrey Levi, executive director of Trust for America's Health, writes about how strong public support for expanded disease prevention programs could help jumpstart the legislative process. This column first appeared in Huffington Post.

As we turn the page to the next stage of debates around health reform, we should remember there is a whole lot in the current Senate and House bills that is popular, already in close agreement, and could be the impetus for moving forward.

The prevention and wellness sections of the bills could help do just that.

A public opinion survey released in November 2009 by Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) found that disease prevention is one of the most popular parts of health reform. In fact, 71 percent of Americans favor an increased investment in disease prevention.

Investing in disease prevention receives majority support from across the political spectrum (85 percent of Democrats, 59 percent of Republicans, and 68 percent of Independents) and across the country (72 percent in the Northeast, 73 percent in the South, 71 percent in the West, and 69 percent in the Midwest), according to the poll, conducted by Greenberg Quinlan Rosner Research and Public Opinion Strategies.

Majority of Americans believe prevention will make us healthier and wealthier

Al Quinlan, president of Greenberg Quinlan Rosner Research, talks about why prevention is one of the most popular elements of health reform.

When it comes to health care reform, one thing is clear: Americans want prevention to play a central role in shaping a new direction for our health care system.

Our latest poll shows strong support for increasing our investment in prevention. When we asked people whether we should invest more in preventative care, 71 percent said we should invest more, as opposed to 23 percent who said we should not.

Even when people learn the potential pricetag with respect to health reform, they support the investment as a way to make people healthier and drive down health care costs in the long run.

Reform's secret weapons: quality measures and the nurses who act on them

Valerie Overton, a nurse practitioner at the Fairview Rosemount Clinic in Rosemount, MN, writes about how nurses are helping clinics improve their quality scores and saving lives along the way.

Measuring and publicizing the quality of health care in communities is crucial to reforming our dysfunctional health care system because it forces doctors and hospitals to improve the care they deliver. A recent Wall Street Journal article showed how this is happening in my state, Minnesota, thanks to the efforts of an organization called MN Community Measurement (MNCM).

Nurses are key players in the reforms unfolding here. As the article rightly noted, doctors “started letting nurses call patients back in if the physicians forgot to order tests during a visit.”  But at Minnesota’s Fairview Rosemount Clinic, where I work, we don’t wait for Twin City-area women to come to us. We write them urgent reminders to get Pap, breast and colon check-ups as well as talk face-to-face about screening. 

Those calls can save lives. Just ask Jean Shanley and Amanda Franco.

What breakfast cereal has to do with health reform

Jim Marks writes about why the decisions we make in the cereal aisle of the grocery store are as important those Congress will make when it comes to health reform.

One of the greatest challenges we face in reforming our nation’s health system is reducing costs. We will never be able to afford a health system that provides all Americans with access to affordable, quality care unless we do all we can to prevent or greatly delay the onset of illness and their associated costs.

Reversing the epidemic of childhood obesity should be right at the heart of that effort, and addressing this crisis would avert untold suffering and enormous expense related to chronic conditions like hypertension and type 2 diabetes. (Don’t just take my word for it—check out this commentary in the New England Journal of Medicine). 

No single piece of legislation is going to cure all of the ills of our nation’s health system, which is why we need to look past the bills wending their way through Congress for solutions that are beyond medical care. True health reform will require action on Capitol Hill, in the White House, in doctors’ offices, in schools and communities throughout the nation—and in the cereal aisle.  Seriously.

$650M for community prevention is milestone on road to reform

Jeff Levi, executive director of Trust for America's Health, writes about how stimulus funds  for community prevention will create a laboratory for what might be achieved with health reform.

The Administration’s announcement Thursday that $650 million in stimulus money will be made available for community prevention and wellness programs is a defining moment for public health in America. It is also an important down payment on the road toward real health reform that will help make Americans healthier.

With two-thirds of Americans overweight or obese and one in five Americans still smoking, this initiative, called Communities Putting Prevention to Work, is tackling two of the biggest health crises in the United States head on.  It will help reduce rates of preventable diseases and give millions of Americans the opportunity to live healthier, higher quality lives. Evidence-based community prevention programs have shown success in improving nutrition, increasing physical activity, and preventing tobacco use by making healthy choices easier choices forAmericans.

What is unique about this initiative is its scale. The program, funded through the American Recovery and Reinvestment Act, will earmark funds for approximately 30 to 40 communities around the country and to states to build or expand upon programs that prevent chronic disease and obesity by addressing physical activity, nutrition and tobacco use. Potentially, it will direct as much as $10 to $20 million to larger cities, representing one of the great advances for prevention programs that this country has seen in decades.

The program will give strong priority to communities that suffer a disproportionate share of preventable chronic diseases and where leaders are able to assemble a communitywide consortium of partners, including the local and state health departments, schools, businesses, community and faith-based organizations, health plans and health centers. At the end of the day, these programs will be the laboratory for showing what results we can have if we invest more heavily in wellness and prevention.

At the end of the day, these investments will be the laboratory for showing what results we might achieve if we invest more heavily in wellness and prevention.

We are convinced they will have a big payoff. In 2008, Trust for America released a study, Prevention for a Healthier America, which found that for every $1 spent on proven community-based disease prevention programs, the county could net a return of $5.60 in health care costs within five years.   On Monday, we’ll release a Compendium of Proven Community-Based Prevention Programs report, along with the New York Academy of Medicine, featuring a range of evidence-based, disease prevention programs that have shown results for improving health and reducing costs.

Finally, this initiative through the American Recovery and Reinvestment Act is a milestone towards the recognition that health reform must start with prevention in order to be successful.   We must take this as a down payment towards the creation of a dependable annual funding stream to allow hundreds of additional communities around the country to benefit from these programs. The future health and wealth of our country demands we improve the health of Americans, not just how we pay for our care.

At yesterday’s briefing, I asked HHS Secretary Kathleen Sebelius where prevention programs ranked on her priority list for health reform legislation.  She replied that it was at the very top – as it was for both the First Lady and President Obama.  Between now and the end of the year when legislation lands on the President’s desk to be signed, I believe it’s the role of the public health community to cement that support, from Congress as well as from the Administration.

To learn more about the Communities Putting Prevention to Work initiative, visit http://www.hhs.gov/recovery/programs/cdc/chronicdisease.html

 

Replacing the shouts of recess with the deliberations of research

Jim Marks continues the discussion about how prevention can be scored.  This post first appeared here as part of Jim's ongoing gig with the Huffington Post. 

During the August congressional recess much of the coverage on health care reform has been spent showing us the cacophony of shouts and yells heard around the country during Town Hall meetings.

But at the same time, with less fanfare and attention, a more measured and productive conversation has been occurring. One that actually has the potential to help make us a healthier country AND provide us with a more cost effective system of care.

Since my August 5 post, “What If Benjamin Franklin Ran the Congressional Budget Office?,” there has been growing interest and attention surrounding the methods of the Congressional Budget Office for scoring costs and savings in general and more specifically as it relates to health reform.

Take Five for health reform

David Colby wraps up his summer reading recommendations for health reform.

I’m going to wind down my summer reading series on health reform because, well, summer’s almost over and Congress is getting back to work.  Although I’ve been somewhat lighthearted in making my reading recommendations, I do hope you know that I know that reading health policy research may not go down as easily as the latest John Grisham or Jennifer Weiner novel (at least, for some of us).  These recommendations were made with two goals in mind—to remind people who care about health reform that facts and sound analysis can and should trump sensationalistic fiction, and to point you to the best examples of what we’ve got by way of facts and sound analysis. 

Before summer officially ends, though, I’m going to take some time to sit on my deck and listen to Dave Brubeck’s Take Five, which is celebrating its fiftieth anniversary this year.  And in that spirit, I’ll encourage you to also ‘take five,” by recommending five topics to learn more about. These are the topics that have dominated health reform discussions in 2009, and they also happen to be five topics on which we can offer you good reading material.  And once again, I’ve tried to make it easier for you readers out there by giving you the gist of what these topics are really about, using literary references that some of you may enjoy. 

Is public health the answer to our problems?

Michelle Larkin writes about the role public health policies and research can play in health reform.

In years past, health reform discussions have focused mostly on providing quality, affordable health care to all and not much on public health and prevention. The past few months suggest that our policymakers now recognize that a strong public health system focused on disease prevention and wellness is something that should be considered as part of a comprehensive health reform plan. 

So, why the increasing attention on public health and prevention?  Well, some of it might just be common sense.  Preventing people from getting sick in the first place makes a whole lot more sense than trying to make them better after they are ill. And since our nation’s public health departments play a critical role in delivering population-based prevention services, it makes sense to ensure they are well-equipped to rise to the challenge of keeping their communities healthy. It might also be that we know more now about how public health works – and we are increasingly able to demonstrate the value of public health and prevention. Sure, there remains quite a bit of discussion on the value of prevention and there is still more focus on clinical prevention over population-based approaches, but most public health practitioners and researchers would agree that progress has been made.  

What if Benjamin Franklin ran the Congressional Budget Office?

Jim Marks writes about CBO scoring of prevention in health reform.  This post also appeared on The Huffington Post today.

While Congress is now its August recess, the country will continue to grapple with a health reform package that is likely to be significantly different from the earlier versions. Among the catalysts for the ongoing debate was the Congressional Budget Office (CBO) estimate of the projected price tag of over $1 trillion for the original proposal that almost ground the prospects of real reform to a halt. 

The CBO was established 25 years ago to “provide Congress with objective, non partisan, and timely analysis to aid in economic and budgetary decisions….” It has turned out to be a powerful voice in the discussions of many important bills.

Within its roles and responsibilities, however, lies a very significant limitation:

According to CBO’s cover letter to the original scoring report “Health Care Reform and the Federal Budget”, “the CBO does not provide formal cost estimates beyond the 10-year budget window because the uncertainties are simply too great.”

Let me repeat that, according to its mandate, the CBO does not look at any return on investment beyond 10 years.

Prevention might be a cure for more than just health care costs

Last week's developments on health reform were mixed:  the President urged Congress to keep plugging away at health reform legislation, as he traveled to Italy; the Blue Dog Democrats set their jaws on the possible price of health reform; and in the meantime, people just kept on doing stuff to improve health care anyway, like the Centers for Medicaid and Medicare Services quietly adding information on hospital re-admission rates to its Hospital Compare web site.  Even though it’s not easy to use, this web site can tell you how hospitals do on things like, uh, patients dying, and how hospitals do on factors like people showing up again at their doors, within the 30-day window after they exited.

Matthew Miller also wrote an article last week on Fortune.com about how investing in prevention won’t save us any health care dollars.  In this article, he calls prevention the “faux panacea” in the health reform debate, and points to the paucity of evidence that exists for whether prevention will end up costing us less, or more, over the long run.

Matthew Miller’s article makes some interesting points, but mostly in response to people who were foolish enough to make some sort of sweeping claim that investments in prevention would solve all of our health care economic woes. 

New Deal 2.0: Wellness for All

(Today's post comes from Dr. Maya Rockeymoore Cummings, President and CEO of Global Policy Solutions, a social change strategy firm based in Washington, DC. and Director of Leadership for Healthy Communities, a national program of the Robert Wood Johnson Foundation.) 

It is perhaps ironic that our country is at the precipice of creating a national healthcare system a full 74 years after President Franklin D. Roosevelt first tried to get universal healthcare passed as a part of the original Social Security Act of 1935.  While many people today aren’t familiar with this important history, FDR’s efforts provide important guidance for today’s healthcare reform debate.
 
Experts agree that rising rates of preventable chronic diseases are driving higher annual medical expenditures. That is why national leaders are seeking to make prevention and wellness a core component of healthcare reform. However, the proposals that have been most discussed will not provide vulnerable populations—those who experience the most sickness and death as a result of preventable chronic diseases—with equal access to prevention and wellness services.