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Putting Our Shoulders to the Common Weal

July 16, 2013

Infographic from the Institute of Medicine

The Robert Wood Johnson Foundation (RWJF) has reconvened its Commission to Build a Healthier America. This comes 4 years after the work of the first commission in 2009, and is hard on the heels of the January report from the Institute of Medicine that documents the alarming state of health in America relative to other affluent countries on most measures of health.

Coincident with the reactivation of the Commission is a RWJF report, Overcoming Obstacles to Health in 2013 and Beyond. In 64 compact pages, with very readable graphics, the report presents data from the IOM study, as well as other ominous facts about dramatic disparities in health among Americans from different income, education, and racial or ethnic groups.

One of the key themes of the Overcoming Obstacles report is the need to broaden the focus to include the social and economic contexts in which Americans live. As an urban planner, and after recovering from my astonishment, I nodded in agreement with the sentence, “Despite existing knowledge, debates about health policy in this country rarely focused on the powerful health influences of non-medical factors such as child care, education, housing, and urban planning.”

But I still don’t see many planners listed among the medical and public health authors in the literature. Actions would speak louder than words, and I tend to agree with Dr. James Knickman, a participant on the IOM Roundtable on Population Health Improvement. He has a written a commentary titled Getting Serious About the Social Determinants of Health, in which he says there has been lots of talk about widening the circle to include experts in social justice, community and economic development, housing, and education. “But,” he says, “there has to be action to get advocates outside of health into these conversations.” I might add that Knickman’s commentary also mentions the reconvened RWJF Commission and its focus on factors that affect health in early childhood and on building healthy communities— synchronicity at work.

Not putting too fine a point on it, the authors of another Institute of Medicine report, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. declare,

For more than a decade, reports of the Institute of Medicine (IOM) have focused attention on a persistent set of problems within the American health care system that urgently need to be addressed, including poor quality; lax safety; high cost; questionable value; and the maldistribution of care based on income, race, and ethnicity. Each report has called for substantive transformation of the nation’s health care system. … But the pace of change is too slow, and adoption is too spotty; the system is not evolving quickly enough. The system needs to learn more rapidly, digest what does and does not work, and spread that knowledge in ways that can be broadly adapted and adopted.

Maybe we have enough roundtables, commissions, and reports. Enough “gaudy patter,” as Dashiell Hammett would say. For some reason, I found the language of the WHO Vienna Declaration on Nutrition and Noncommuncable Diseases in the Context of Health 2020 more compelling, more credible. It was hammered out on July 4 and 5, while we were celebrating independence from Great Britain. The Vienna Declaration uses lots of action verbs and describes tangible objectives. And it conveys a powerful sense of collective purpose to improve what used to be called the common weal. Is that what we’re missing?

—   Michael Lytton, AJPM Blog Editor


Further Reading in AJPM:

Lavizzo-Mourey R, Williams DR.  Strong Medicine for a Healthier America: Introduction. Am J Prev Med 2011;40(1S):S1­–3.

Braveman PA, Egerter SA, Mockenhaupt RE. Broadening the Focus: The Need to Address the Social Determinants of Health. Am J Prev Med 2011;40(1S):S4–18.

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