The goal of optimal health policy is to remove barriers to achieving the highest-quality health care at the lowest cost for the most people. This is a tall order requiring the best and most informed minds, many of whom are leaders and teachers within academic health centers and their university communities. Not only can those of us in academic health centers make excellent policy proposals, but we also can be the engines for change. We learn from the literature, our colleagues, and the students we teach; we do research; and we bring that research into practice to improve effectiveness, efficiency, and eventually coverage. For example, five years ago, in the MBA class I was teaching, the students proposed a “fast food tax” to pay for the uninsured; they calculated that a 5% tax on fast food would generate $46 billion in the United States—enough to reduce the number of uninsured by 50%. The University of Virginia’s health system took that idea and a year ago put into effect a “fatty food tax” of five cents on the least healthy items in our institution’s vending machines—and color-coded all the items. At the end of a year, the unhealthy red foods were down 5%, yellow up 30%, and green (the healthiest) up 15%, with overall sales up 5%. This idea (without the tax) was even piloted in a state building by the Virginia Secretary of Health. Next step: the public schools. This is just one of many cases where an idea originating from students and faculty moved into practice in a short period of time.
In this issue of Academic Medicine, a distinguished group of experts present their views of specific health policy issues and share their ideas on how we in academic medicine can help study and move health policy in the areas they discuss. Each author identifies problem areas and suggests the role of academic health centers in the application of findings to patients and society through a variety of strategies. The themes are remarkably consistent: the need for academic medicine to collect and disseminate data on best practices, to create and use guidelines to reduce practice variations to foster greater patient safety and reduce health disparities, to use evidence-based formularies, improve efficiency (e.g., offering models for administrative waste reduction), and to improve the appropriateness of tests and visits. Many of the recommendations apply to all of medicine but are also highly applicable to academic health centers, such as suggesting that they take the lead demonstrating potential improvements in the malpractice system, and promoting prompt disclosure and earlier settlements. Some recommendations apply specifically to academic health centers: they should provide telemedicine to rural areas, educate more members of underrepresented minorities, improve patient safety in clinical research protocols, and initiate clinical trials on new treatments directed specifically at complex patients. Finally, in this issue, we in academic medicine are reminded of our crucial role in advocacy at the federal and state levels. For example, at the federal level, we can advocate ways to increase the numbers of physicians and other needed health care professionals. Our role at the state level is at least as important, since most of us in leadership positions in academic medicine have important relationships with state officials. Since it appears that innovation in health care may be at the state level at least for the next few years, it is at that level that we can be most helpful in formulating policies and implementing programs.
In short, the articles in this issue show clearly that those of us in academic medicine, especially in academic health centers, can improve the health of America by affecting health policy. We should seize the opportunity to contribute without delay.