Health Researchers Create Landmark National Academy of Medicine Report.
Despite the powerful effects of social and behavioral factors on health and longevity, US health policy has largely ignored them, focusing instead on clinical care.
Now, a group of leading health researchers that includes Sandro Galea, dean of the School of Public Health, is advocating a new national agenda that focuses attention on factors outside the medical system—from earned income tax credits, to criminal justice policies—that will improve population health.
Galea is among more than 100 researchers, scientists and policy makers from across the US selected by the National Academy of Medicine (NAM) to prepare expert papers on 19 priority areas for US health policy. The NAM report, “Vital Directions for Health and Health Care,” is intended to provide guidance for the next Presidential administration and health care policymakers. It includes recommendations for care coordination, eliminating disparities in access and care, and rapid adoption of scientific advances.
The paper that was co-authored by Galea and six other experts, titled, “Addressing Social Determinants of Health and Health Inequities,” cites research showing that life expectancy in the US is shorter than that of other high-income nations, and that health disparities are greater.
“Health inequities are not inevitable; actions that lessen social disadvantage can reduce gaps in health and longevity,” wrote the group, which includes Howard Koh, former US assistant secretary for health for the Department of Health and Human Services. “Health policies need to expand to address factors outside the medical system that promote or damage health.”
Among the programs that the group advocates expanding are home-visiting programs for pregnant women and parents of young children; earned income tax credit benefits, which lift working families out of poverty; occupational safety oversight and enforcement; financial assistance to family caregivers; and health care programs, including mental health, for juveniles and adults involved in the criminal justice system.
In the area of behavioral risk reduction, the panel recommends investments in early-life interventions, such as nutrition assistance and access to high-quality pre-school and childcare. Galea and colleagues also push for action on the controversial issue of firearms safety, which they argue should be properly considered a public health concern.
“More than is the case with any other health issue, developing and testing effective programs and policies to reduce firearm-related morbidity and mortality are hampered both by a paucity of relevant data and the lack of a coordinated approach to regulation of what is a dangerous consumer product,” they wrote. They advocate for a “national research infrastructure” that would include sustained funding for gun violence prevention.
On health financing, the experts push for payment mechanisms that value prevention over acute care, including pay-for-performance and bundled-payment systems. They also call for insurance reforms to eliminate high cost-sharing for the management of chronic diseases, as well as an expansion of Medicare, Medicaid and other health plans to include dental care.
“A number of policies addressing social and behavioral determinants of health would entail little or no additional cost,” the report concludes. “Such policies typically are not viewed as ‘health policies,’ but, in fact, have great potential to reduce health inequalities and improve the health and longevity of all Americans.”
Besides Galea and Koh, co-authors on the paper were: Nancy Adler, Jonathan Fielding and Maria Glymour of the University of California; David Cutler of Harvard University; and David Satcher of the Morehouse School of Medicine.
The papers in the report will be discussed at a September 26 public symposium in Washington, DC, which will inform the Vital Directions steering committee on a final publication, expected later this year.