The Robert Wood Johnson Foundation Commission Calls for Shift in Funding Priorities to Ensure All Children have Access to Early Childhood Development Programs by 2025
Washington, D.C. - Social factors have as much or even more impact on health as the medical care system. In light of this reality, the nonpartisan Robert Wood Johnson Foundation (RWJF) Commission to Build a Healthier America today urged leaders across the U.S. to shift funding priorities to emphasize three areas essential to improving the nation's health: Increasing access to early childhood development programs; revitalizing low-income neighborhoods; and broadening the mission of health care providers beyond medical treatment.
The Commission has determined that these areas have the greatest potential for improving the health of the population, especially for low-income families, and offer the greatest opportunities for collaboration.
Chaired by leading economists Alice M. Rivlin, PhD, former director of the Office of Management and Budget, and Mark McClellan, MD, PhD, the former head of the Centers for Medicare & Medicaid Services, the 16-member Commission was first created in 2008 and issued 10 recommendations in 2009 for improving the health for all Americans. The Commission reconvened last year to build on its earlier work and identify actions that should be taken going forward. Its new recommendations, contained in the report Time to Act: Investing in the Health of Our Children and Communities, are issued against a national backdrop of widening income inequality, with many watching their ability to maintain good health for themselves and their families slip away.
"We cannot improve health by putting more resources into health care alone," McClellan said. "We must find ways to help more Americans stay healthy and reduce the health care costs that are crowding out other national priorities."
After months of examining evidence and learning about successful initiatives, the Commission issued recommendations that call for realigning resources and expanding programs and systems to improve health for generations to come. The primary recommendations are:
- Support the nation's children, especially those who are most vulnerable, in their earliest years when health begins. Fund enrollment for all low-income children in quality early childhood development programs by 2025.
- Change our approach to revitalizing communities, especially low-income neighborhoods, to create healthy communities and make healthy decisions possible for all Americans.
- Broaden the mission of the U.S. health care system to address nonmedical factors that affect health, and connect patients to resources and services in the community that can improve their ability to pursue better health.
"To achieve a healthier America, we must change our approach to investing in health to affect the actual determinants of health, not just the consequences of ill-health," Rivlin said. "If carried out, these recommendations will build a foundation of lifelong health for generations to come."
"As a nation, we have a responsibility to do right by society's most vulnerable members and by our future generations," said RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA, who called on leaders from across all sectors to work together to advance the Commission's recommendations. "We must join forces to foster a culture of health in which everyone-regardless of where they live, their race or ethnicity, or how poor or wealthy they may be-has the opportunity to lead a healthy life."
Making America's Youngest Children the Number 1 Priority
A strong body of evidence demonstrates that early childhood experiences and environments can greatly affect health well into adulthood. Sustained exposure to toxic stress from abuse, neglect, neighborhood violence, and chronic poverty can affect brain development and disrupt biological processes leading to serious illness later in life, including heart disease and diabetes.
Although the U.S. invests significantly in K-12 education, health care, and other support programs, it does not invest as heavily in the earliest years when children's brains are developing. It is past time, the Commissioners said, to make investment in our youngest children a national priority.
From the White House to the U.S. Chamber of Commerce, there is growing recognition of the importance of early childhood programs to lifelong success and well-being. Children who attend such programs are more likely to stay in school, get jobs, and earn more money-all of which are linked to better health.
The Commission recommends:
- Ensure access to quality early childhood development programs for all preschool children from low-income families by 2025.
- Strengthen quality standards for early childhood programs.
- Link funding of early childhood programs to performance.
- Help parents who struggle to provide healthy, nurturing experiences for their children.
Making America's Neighborhoods Places Where Everyone Can Thrive and Be Healthy
Nearly one-fifth of all Americans live in low-income neighborhoods that offer few opportunities for healthy living. In these neighborhoods, job opportunities are scarce, access to adequate housing and nutritious, affordable food is poor, and pollution and crime are prevalent. These factors all affect health.
Creating healthier communities-and lives-requires considering the health impacts of all aspects of community development and revitalization. A broad range of sectors, including public health, health care, education, transportation, community planning, and business, must work together to achieve common goals.
The Commission recommends:
- Support and speed the integration of finance, health, and community development to revitalize neighborhoods and improve health.
- Create incentives and performance measures to spur collaborative approaches to building healthy communities.
- Replicate promising, integrated models and invest in innovation.
Making Health-Not Sickness-the Focus of Health Care
To help their patients achieve better health, health professionals and institutions must learn to address the nonmedical causes of poor health. In addition to conventional vital signs such as heart rate, blood pressure, and temperature, nonclinical vital signs such as employment, education, and housing provide important information about a patient's health. Health professionals need training and support to identify the realities in patients' lives that most significantly impact their patients' health, and to connect patients with resources in their communities that can help them overcome barriers to good health.
The Commission recommends:
- Adopt new health "vital signs" to assess nonmedical indicators for health.
- Create incentives tied to reimbursement to help increase the use of these new nonclinical vital signs.
- Incorporate key social and environmental factors that influence health, such as housing and employment, into community health needs assessments.
The Commissioners noted that, throughout their deliberations, they were encouraged by promising examples of cross-sector collaborations, innovation, and success throughout the country. Many of these examples are highlighted in the Commission's report. For more information about the Commission and for a copy of the report, Time to Act: Investing in the Health of Our Children and Communities, go towww.rwjf.org/commission.
Members of the RWJF Commission to Build a Healthier America:
- Mark McClellan (Co-Chair), The Brookings Institution
- Alice M. Rivlin (Co-Chair), The Brookings Institution
- Katherine Baicker, Harvard School of Public Health
- Angela Glover Blackwell, PolicyLink
- Sheila P. Burke, Kennedy School of Government, Harvard University
- Mitchell E. Daniels, Purdue University
- Shirley Franklin, Purpose Built Communities
- Kati Haycock, The Education Trust
- The Rev. Dr. Eileen W. Lindner, Health Task Force, National Council of Churches USA
- Rebecca Onie, Health Leads
- Kyu Rhee, IBM
- Dennis Rivera, SEIU Healthcare
- Marla Salmon, University of Washington
- Carole Simpson, Emerson College School of Communication
- Reed Tuckson, Tuckson Health Connections, LLC/ formerly UnitedHealth Group
- Anne Warhover, Colorado Health Foundation
- David Williams (Staff Director), Harvard University