Commission to Build a Healthier America

America is a country founded in the pursuit of a vision, the realization of an ideal. In words that are built into our national DNA, all of us are created equal, endowed with the inherent and inalienable right to life, liberty and the pursuit of happiness. None of that is possible without good health. Unfortunately, today, when it comes to health and health care, we are not all equal, are we?

The health of America depends on the health of all Americans. And when huge numbers of us are left behind, more of the nation’s future is left behind as well. What would the signers of the Declaration of Independence think of our country today if they knew that where you live predicts your life expectancy, your health is poorer if you are poorer, and your baby is much more likely to die if you haven’t finished high school? Life isn’t just better at the top, it’s longer and healthier. The problem is real. But in the United States, where disparities in health are enormous, the problem has been largely anonymous. America’s public debate on “health” has mostly centered on access to and affordability of care, even though a large body of evidence tells us that whether or not a person gets sick in the first place in most cases has little to do with seeing a doctor. A far greater determinant is the sometimes toxic relationship between how we live our lives and the economic, social and physical environments that surround us. Some of the factors affecting our health we certainly can influence on our own; many of the factors, however, are outside our individual control.For more than a generation, the Robert Wood Johnson Foundation has pioneered the research and knowledge that brings us to this understanding. Now it’s time to chart the way forward, identify workable solutions and motivate others to act.

  

Differences in health along social, economic and racial or ethnic lines are  known as “health disparities” or “social disparities in health.” New research presented in this report—and supported by previous studies—indicates that these differences are keeping America from reaching its potential. They represent preventable illness and loss of life and compromise Americans’ quality of life and our productivity as a nation.The conclusions of this report suggest that reducing America’s large and persistent health disparities requires taking a broader, deeper look at how health is shaped across lifetimes and generations. Finding solutions to avoidable differences in health requires looking beyond the medical care system to acknowledge and address the many other factors that also can determine a person’s health.

This report from the Robert Wood Johnson Foundation:

•           Examines the roles of personal and societal responsibilities for health within the contexts in which people live, work and learn which influence both the choices people have and their ability tomake healthy choices.

•           Reviews evidence of the lasting impact that physical and social environments have on a child’s health and on his or her chances of becoming a healthy adult.

•           Reveals new national evidence of differences in health across income and education groups, and how they relate to differences in health by race or ethnicity.

•           Provides new evidence of the economic and human costs of social differences in health, including the life stories of three American families who are trying to make healthy choices but face major obstacles.

•           Offers a framework for finding solutions by applying current knowledge about the underlying causes of social disparities in health.