As we begin a new year, health care is center stage, spinning in a tight pas de deux with the economy as the dominant domestic issue in the 2008 presidential campaign. For the first time, every candidate for president has a real plan to improve health care and they even bicker over the details! That is the good news. So is the focus on cost, coverage and most importantly, change.   

When it comes to health care, we can all agree that change is desperately needed.  The major health problems of our time will not be solved within the clinical care system as it is currently built, nor simply by addressing health care costs or expanding coverage. We can’t afford to just throw more technology or more intensive treatment at people, nor should we have to.  More treatment isn’t the right prescription.  We need better treatment and we need less disease if we want good health for all. 

Americans have worse health outcomes than patients in other industrialized nations, even though we spend nearly three times more on health care per person.  We rank 46^th globally in average life expectancy and 42^nd in infant mortality. Race, ethnicity and income inequality affect the health of millions and the care they receive

America is founded in the pursuit of a vision, the realization of an ideal.  In words that are built into our national DNA, all of us are created equal, endowed with the inherent and inalienable right to life, liberty and the pursuit of happiness.  None of that is possible without good health. Making sure that every person in America has a fair chance for a healthy life and an equal opportunity for adequate health care is not about ideology, it’s about the future of our nation.

Unfortunately, in today’s America, when it comes to health and health care, we are not all equal, are we?  In the U.S., health disparities are enormous. Decades of expert research tells us that education, economic development, housing, job security, geography, and income all affect health just as strongly as personal behavior.  We even know now that poverty contributes to mortality of American adults at about the same rate as cigarette smoking.  Right now, there are more than 47 million people in the United States without health insurance. The uninsured not only get sicker, but their outcomes are worse. In addition to those without coverage, there are many people who only have access to poor care, but don’t even know it. 

The time has come to bridge the gap between “what we know” and “what we do.”  Here’s this doctor’s prescription for what it will take:

Collaboration is key.   Without it, the financial, clinical, professional and personal forces that frame our health and health care universe will continue to struggle with many of the same old pieces of the puzzle.  People tell us they want to be more engaged in making their own health care decisions in partnership with doctors they choose, know and trust.  They want doctors, nurses and hospitals to publicly report how they perform and they want to see solid evidence of what works best for them as patients.  They want environments that make healthy choices the easy choices.

We know how to deliver better care.   For a long time we have worked with our partners, collaborators and grantees to develop and test new ways to improve the quality of patient care at the national level. Now we are applying the lessons we’ve learned in a model group of communities of all shapes and sizes.  In these markets, we are helping local teams of doctors, nurses, hospitals, employers, insurers and patients re-align their perceived interests to bring better quality of care to the people in their own distinct regional health care marketplace. 

Improvement is key too.   People want their doctors, nurses and other health care professionals to hold “do it better” along side “do no harm” as the highest of their professional standards.  They want everyone to receive exactly the same high quality of care.  And people want their own voices heard as the community figures out how it is going to retool health care.

We must broaden our focus of what constitutes a “health issue.” Good health comes from healthy lifestyles, good choices, and a supporting environment in which to make those good decisions. While quality has long been at the top of the agenda when it comes to health care, it has only recently received attention in public health circles. As a society, we have not developed good ways to measure quality in public health practice, and we have not communicated the outcomes the public should expect from their local and state health authorities – such as immunizing all children, eliminating tobacco use and promoting regular physical activity  – to people’s daily lives. Communicating the results that public health can deliver is critical to achieving such broad societal goals.  Take childhood obesity.  We’re at risk of raising the first generation of Americans to face substantially more disability and disease than their parents. A recent New England Journal of Medicine study shows that up to 37 percent of male and 44 percent of female teenagers in the U.S. will be obese by the time they turn 35 in 2020. Federal officials already put the cost of related medical expenses and lost productivity at $117 billion per year, and researchers predict one of every five dollars spent in the future on elder care will be related to obesity. These trends must be reversed, and we need to establish performance baselines and benchmarks that will help improve public health agencies’ performance and make them accountable to the people they serve.

Change is in the air across the country and across the health and health care spectrum.  We are close to comprehensive system reform in the here and now, for the common good and for everyone in America.  This isn’t theory.  This isn’t rhetoric. This is action. The path toward improving the quality of care in the U.S. is clear, straight, and passable.  We expect success because the only ideology that counts here is the healthiest possible state of the union for all Americans. 

As we move forward together in 2008, I look forward to sharing news of programs, progress and impact.  If you haven’t already, I encourage you to visit rwjf.org , sign up for our  information updates, and join us on our exciting journey .