"America`s Health: Results from a Generation" Robert J. Gould, Ph.D. President and CEO Partnership for Prevention

It is generally accepted that the span of a generation covers about 20 years. If that`s true, it means America`s Health RankingsTM has now been tracking state-by-state efforts to improve the nation`s health over the course of an entire generation. This provides a good vantage point from which we can identify successes and lost ground, opportunities taken and opportunities missed.

While it has been a generation in which we`ve seen positive developments in areas such as tobacco use, cancer, and infant mortality, the inescapable conclusion from a 20-year overview is that in many areas we are hitting a wall, and further improvements in health status will require new strategies.

Nearly all of the leading causes of death in the United States today are chronic diseases - heart disease, cancer, stroke, chronic lung diseases, and diabetes. But those statistics don`t tell the full story. The primary drivers of poor health and high health care costs are behaviors - tobacco use, poor diet, physical inactivity, and alcohol consumption - that are largely preventable.

The steady upward spiral of the incidence of chronic disease poses a severe financial threat to our health care system and economy, but even worse is what it portends for Americans in the future. Today`s children already face the prospect of being the first generation in U.S. history to live sicker and die younger than their parents.

Clearly, the path we are on is unsustainable. We must ensure that our approaches to improve health address the underlying causes of poor health, health disparities and high health care costs. These include the economic, social and physical environments that can hinder healthy behavior and that can contribute to stress, poor educational outcomes and medical illiteracy. Without addressing these underlying drivers, we will never be able to do more than provide temporary solutions to the difficult problems facing our health system and the nation`s health.

There are many policies, programs and services that have been proven to be effective in addressing these underlying drivers of ill health. These interventions include programs and policies that foster environments within the community that support healthy behaviors and healthy choices. They also include services that are delivered within the clinical health care system.

Our progress in reducing tobacco use among adults from 42% to 18% over the last 40 years serves as an example of how policy and program interventions can produce enormous health benefits. Successful tobacco prevention policies and programs have included media campaigns, higher tobacco taxes, smokefree policies and free telephone counseling services for tobacco users. But progress in reducing tobacco use has largely plateaued in recent years, making it imperative that we strengthen our efforts on tobacco.

Meanwhile, an epidemic of obesity threatens the health of millions of adults and, increasingly, the future health of today`s young people. While obesity has serious medical consequences, the medical community-oriented approach cannot reverse the epidemic. Only a multi-pronged, policy and community-oriented approach will help create the healthy environments to facilitate good nutrition choices and opportunities to engage in physical activity.

Congress was still grappling with health reform legislation as this report went to print. Even if prevention provisions in the legislation should win passage, there will be much to do. Fortunately, private-sector corporations are already seeing a return on their investments in prevention and wellness; as a result, they are not cutting their investments in these areas, even while they make other budget cuts and staff reductions. Some have come to appreciate the value of prevention to the extent that they are even reaching beyond the company walls to help promote and participate in community prevention efforts.

Also, many states are already far ahead of Congress, and this report provides some examples of states that are leading the way in increasing access to quality, affordable health care, raising the priority on prevention, incentivizing employers to invest in workforce health, and implementing policies that are proven to improve health.

Partnership for Prevention has developed the following policy recommendations to guide efforts at the federal, state and local levels to invest in policies, programs and care aimed at keeping people healthy.

That means high-quality affordable health care, including high-value preventive services such as screening tests, immunizations, and counseling, should be available to everybody. Financial incentives should be put in place to encourage patients to use preventive services, for doctors and other providers to offer them, and for employers to become actively involved in promoting their employees` health.

As a country we need to invest in healthy environments. We need to create incentives for public health departments, schools, parks, recreation departments, and nonprofit organizations to offer prevention programs and services and to help implement focused health promotion campaigns. Even more importantly, health effects should be factored into all our decision-making, including decisions about urban planning, land use, zoning, transportation, and agriculture. The goal should be to make the healthy choice the easy choice for all Americans.

Clinical and community-based prevention reinforce each other. When we link clinical services delivered through traditional settings to community services delivered through our public health system and non-traditional settings, we can make real progress, as we have done historically with such health threats as smallpox, infectious diseases, unsanitary water and waste disposal. Comparative effectiveness research should include prevention, particularly community preventive services. These types of analysis can help states and communities identify policies and practices that will have the biggest impact.

More information on these policy recommendations is available at www.prevent.org.

We`re at a critical crossroads. We`ve seen a generation`s worth of losing ground to the risk factors that threaten the longevity of our children and the vitality of our economy. We`ve also seen the promise of how, by investing in keeping people healthy, we have the potential to provide a better future for generations to come. If you`re reading this report, it`s up to you to help get us on the right path.