Jarris, Paul E. MD, MBA; Schneider, Julia Pekarsky MPH
The Association of State and Territorial Health Officials, Arlington, Virginia.
Correspondence: Julia Pekarsky Schneider, MPH, The Association of State and Territorial Health Officials, 2231 Crystal Dr, Ste 450, Arlington, VA 22202 (firstname.lastname@example.org).
The authors declare no conflicts of interest.
We encourage state and local health officials to work with their agency counterparts in government and the private sector to pursue a Health in All Policies approach in support of the National Prevention Strategy.1 “The goal of the National Prevention Strategy is to increase the number of Americans who are healthy at every stage of life,” says US Surgeon General Regina Benjamin, MD, MBA. “I look forward to working with our state and local partners to help us become a more healthy and fit nation.” ASTHO and our members are working with Dr Benjamin to collaborate with other sectors and promote achievement of their mission in a manner that promotes and protects health. We urge all agencies and organizations to identify ways in which they can support the National Prevention Strategy, both in the work that they do and as an employer.
The typical patient with a chronic disease sees their doctor for about 30 minutes every quarter. That comprises 0.2% of their life spent in the doctor's office. The remaining 99.98% of their life is spent out in the real world making health decisions: in homes, schools, worksites, restaurants, and religious institutions. Yet, when it comes to health, most of our attention is focused on the health care setting rather than other environments with a greater influence on our emotional and physical well-being. This is especially apparent when you look at health care spending, with only 3.1% dedicated to public health approaches that support prevention while the rest is spent on treatment. This disconnect is why the Institute of Medicine recommends a more prevention-oriented health system, with more funding and support for state public health systems.2
In addition to environmental factors, social determinants of health, including economic and social conditions such as poverty and inadequate education, influence the health of populations and contribute to chronic disease.3 These underlying health inequities impose great but often unseen costs. According to a report of the Joint Center for Political and Economic Studies, the indirect costs of health inequities in the United States were $1.24 trillion between 2003 and 2006.4
We need to help US communities support and foster the health of our nation, rather than simply focus on treating disease and disability after the fact. There is a growing movement in the United States to approach health in such a fashion, and it is gaining support among our nation's top leaders. The time is now!
State and territorial health agencies, along with federal, state, and local governments, can provide the leadership necessary to change our nation's approach to health. National and federal strategies, such as the National Prevention Strategy, serve as roadmaps for state health agencies to address priority areas such as healthy eating, active living, tobacco control, and injury prevention across various sectors. Community Transformation Grants, coordinated chronic disease programs, and similar initiatives provide funding and infrastructure needed to provide epidemiology and surveillance, support and reinforce healthful behaviors, improve the delivery and use of clinical and other preventive services, and establish community-clinical linkages to support prevention, control, and management of chronic diseases.
Such strategies and programs cannot be created by health agencies working alone. Through the Affordable Care Act, the National Prevention Council was created to bring together 17 federal departments, agencies, and offices. Chaired by the Surgeon General, this council developed the National Prevention Strategy, with input from the Prevention Advisory Group, stakeholders, and the public.
This national strategy aims to guide the United States in the most effective and achievable means for improving health and well-being. It prioritizes prevention by integrating recommendations and actions across multiple settings to improve health and save lives. Over time, this national, cross-agency framework has the potential to address a comprehensive public health agenda, including social determinants of health, to support enhanced collaboration across sectors.
In support of the National Prevention Strategy, ASTHO is working with the Centers for Disease Control and Prevention and the Office of the Surgeon General to enhance collaboration among organizations such as ours, which represent state leadership in several areas represented by the National Prevention Council. On February 28, we brought together federal departments that serve on the National Prevention Council such as the Departments of Education, Justice, Defense, Homeland Security, and the Office of National Drug Policy and national membership organizations that were identified by the federal agencies. This diverse group of stakeholders identified opportunities to work together to support state agency members in pursuing the implementation of the National Prevention Strategy. Meeting participants were asked to state how their members support health and wellness. Answers ranged from supporting the military community and veterans to implementing school physical activity and nutrition standards, raising awareness about the health benefits of volunteering, changing transportation models to incorporate more walking, and ensuring that people can age in place.
If we as national organizations can be a model for change, this can create a leverage point for state health officials to better collaborate with their governmental partners and the greater community. As an example, the California Health in All Policies Task Force, created to fight the obesity epidemic through a 2010 executive order by Governor Arnold Schwarzenegger, is composed of representatives from 18 diverse state agencies, including those that address housing, transportation, education, workforce development, parks, and planning.
In Massachusetts, Governor Deval Patrick signed a transportation reform law that established the Healthy Transportation Compact, an interagency initiative that promotes collaboration between the state's Executive Office of Health and Human Services, Department of Public Health, Department of Transportation, and Executive Office of Energy and Environmental Affairs. Now, public health leaders pool their expertise with that of transportation and environmental experts in a collaborative and proactive process to create transportation projects that promote health and optimal transportation design from the beginning.
More of these examples can be found every day at the federal, state, and local levels. The tide is changing, and ASTHO stands ready to work with partners from all areas to support the work we are doing with the Centers for Disease Control and Prevention and Surgeon General Dr Benjamin to foster collaborative relationships and innovative ideas to improve the health of our nation. We hope that your organizations are also using the National Prevention Strategy as a new way of looking at public health and that we can all work together to create a better health system.
Public health officials are well positioned to pursue the goal of Health in All Policies. We encourage sector leaders to work together to improve the health of our nation. Through implementation of the National Prevention Strategy, we can help others do well by doing good.
1. National Prevention Council. National Prevention Strategy. Washington, DC: US Department of Health and Human Services, Office of the Surgeon General; 2011.
3. Commission on Social Determinants of Health. Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. Final Report of the Commission on Social Determinants of Health. Geneva, Switzerland: World Health Organization; 2008.
4. LaVeist TA, Gaskin DJ, Richard P. The Economic Burden of Health Inequities in the United States. Washington, DC: Joint Center of Political and Economic Studies; 2009.
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