Using public policy as a tool to improve health

Georges Benjamin, at left, moderates the Joan H. Tisch Forum in Public Health at Hunter College with Bruce Vladek, Rich Besser and Jim Marks (from left to right). Photo courtesy Philip Kessler Photography

Our nation is undergoing a significant debate about how best to improve the health of its citizens. Much of that debate has been around insurance coverage and reform. While this is an important debate, much of what influences the degree of healthiness of individuals and communities is outside the traditional health system.

Health is about our housing; where we dump our trash; access to clean, affordable and safe food, water and air; how we build our communities in terms of their ability to support active living and the presence of economic opportunity. These factors are affected by public policy decisions and therefore can be used strategically and on a population basis to improve health.

New York City has used this approach to great effect. They have relied on the findings of community health surveys to determine their health priorities and then developed many of the city’s most significant policy initiatives, including food environment policies such as banning trans fats at restaurants and requiring calorie-count restaurant displays, increasingly aggressive anti-smoking policies, increased bicycle paths, improved access to fresh fruits and vegetables, and a novel registry to track diabetes control.

I had the pleasure this week of moderating a discussion with three distinguished figures from the worlds of health policy, health administration, philanthropy and media at the Joan H. Tisch Forum in Public Health at Hunter College. Together, we discussed some of these initiatives and explored the valuable and necessary role of public policy as a health improvement tool.

James S. Marks, MD, MPH, senior vice president and director of the Health Group at the Robert Wood Johnson Foundation, reminded the audience that the World Health Organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. He further discussed the importance of addressing the social determinants of health and their impact.

Richard E. Besser, MD, MPH, chief health and medical editor with ABC News, talked about the importance of using sound evidence to make informed decisions to improve and maintain health and the challenges of explaining those decisions to the public. He also pointed out that it is often not that the decision is wrong but it is in the execution of explaining it to the public that derails many interventions.

Bruce Vladeck, PhD, senior advisor to Nexera Inc., discussed the importance of the linkage between health care services and public health. He also pointed out the role income inequality has on health and that many of the social determinants are surrogate markers for this important disparity.

We had a spirited discussion and debate about the relative importance of these various determinants of health. In the end, it was clear that the benefits of using broad public policy to improve health are significant and are essential to improving the health of our nation.

More about the Joan H. Tisch Forum in Public Health, “The Role of Public Policy as a Health Improvement Tool,” held Dec. 14, 2011, can be found online.