By David A. Kindig, MD, PhD
I listened carefully, but I don’t think I heard the words population health, public health, or prevention anywhere in the speech. But I think Obama is a closet population health advocate like Sam Brownback and Peter Orszag.
There was no mention of health outcomes, disparities, or even national health performance goals -- where we have much work to do, especially in relation to other countries. However, the domestic part of the speech dealt primarily with two major drivers of health -- education and jobs (fully 40% of the health factors score in our County Health Rankings is made up of social and economic indicators such as these).
Effective education policies have the dual benefit of improving both educational attainment and health status across the lifespan, from the earliest intrauterine life stages through formal schooling and beyond. And, in an evening when bipartisan dating was a major sub-theme, this should appeal to liberals and conservatives alike since it expands opportunity without the government directly reallocating resources.
In my experience, much of the population health research and advocacy in the areas of income and employment has focused on more liberal-leaning public governmental policies such as tax reform, income enhancement programs like earned income tax credits (EITC), and public job creation. These are important, but job creation is primarily in the private sector, and policies improving economic competitiveness need to be supported as well. I don’t know what the right balance between these is, but it should be made on evidence rather than ideology from either side of the dating game. The President also emphasized our expanding opportunities to create jobs in the clean energy sector; weaning off coal and oil has secondary unmentioned health benefits as well.
We did hear the word health, but of course only in the context of health insurance reform. Even though the County Health Rankings model only ascribes 20% of health outcomes to healthcare, it is critically important that all Americans have access to it. So I applaud the President for standing firm on this. Acknowledging that the Patient Protection Act is not perfect, he expressed hope for bipartisan enhancements. Though the President did not directly address the specifics of healthcare cost containment, it must remain a high, common ground priority on the health reform agenda. I believe we could and should eliminate or rationally ration high cost treatment options that offer little or no benefit, for both deficit reduction and redirecting savings towards prevention.
So population health improvement and disparity reduction did not rise to the level of an explicit State of the Union “Winning the Future” theme. But many of the featured components are so important in their own right that the combined secondary effect could represent a bipartisan stealth attack on this critical challenge.
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.
These are important, but job creation is primarily in the private sector, and policies improving economic competitiveness need to be supported as well.
Posted by: Josh | 02/10/2011 at 03:52 AM