Sam Brownback of Kansas (R): A Population Health Governor?

By David A. Kindig, MD, PhD

I can understand how readers of this blog could think that population health improvement is an agenda owned by liberals. After all, reducing disparities and social determinants do not at first blush have a conservative or free market ring.  But I think it is short sighted and ideologic to draw the conclusion that there cannot be substantial conceptual and political common ground.

An old friend and colleague, Dr. Robert St. Peter of the Kansas Health Institute, spoke earlier this month at the National Health Policy Forum. During his talk, he mentioned Sam Brownback’s recent and successful gubernatorial campaign in Kansas, which focused on Five “Roadmap” Policy Priorities:

• Increase in net personal income
• Increase in private sector employment
• Increase in the percentage of 4th graders reading at grade level
• Increase in the percentage of high school graduates who are college or career ready
• Decrease in the percentage of Kansas children who live in poverty

If this isn’t a population health agenda that everyone in our field could embrace, I’ve not seen one. Of course the devil is in the details and implementation, and there are some strategies that liberals will not be comfortable with. But the metrics are clear and solid; at the very least this Kansas/Brownback Roadmap deserves understanding and careful tracking over the next 12-24 months.

Last week’s post highlighted the importance of income as a health determinant, operating through multiple pathways such as behavior, health insurance, health literacy, and the physical environment. Liberals often think of increasing income through income supplementation and welfare policy; these are powerful tools that need to be effectively deployed. A recent paper by two economists showed that modest increases in the Earned Income Tax Credit in 1993 produced measurable increases in physical and mental health outcomes.

Both parties are acknowledging the political and economic imperative of jobs creation, prioritizing the need for better jobs with livable wages. Common ground on this and similar population health policies needs to be cultivated not only between sides of the aisle but also with the business community. Business leaders have an inherent interest in population health policy, recognizing the importance of both employee health and education for their impact on health care costs and productivity. In the past, businesses have tended to emphasize wellness and incentives for individual behavior change. However, there is increasing recognition of the need to shift to a broader perspective. Andy Webber, CEO of the National Business Coalition on Health, recently noted in a MATCH project essay published in Preventing Chronic Disease:

“An employer can do everything right to influence the health and productivity of their ‘captured’ workforce at the worksite, but if that same workforce and their dependents live in unhealthy communities these employer investments can be neutralized.” 

Certainly the Brownback Roadmap would go a long way in helping employers achieve these goals. He could make it stronger by calling for elimination of ineffective healthcare practices and using the savings to fund his roadmap. The population health agenda is too large for a single party and political perspective. Our current bipartisan concerns about the economy provide fertile common ground for a population health policy agenda that would reap benefits for decades to come. That would be political cooperation worth working for.

David A. Kindig, MD, PhD is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health.

Comments

[Jim Marks]

Senator Brownback has also been interested in issues of food marketing to kids-being sponsor of a group to examine what industry should do to improve in this area. And interested in cancer prevention and control.