Coalition to examine health, poverty link

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A coalition of leaders from the business, health care and education sectors said yesterday that they will examine how factors such as income, housing, education and stress — not medical insurance — shape the health choices people make and cause poor and middle-class people on average to live shorter lives than wealthier Americans.

The Robert Wood Johnson Foundation, which created the Commission to Build a Healthier America, yesterday released a report that found that Americans who haven't finished high school are more than four times as likely to be in poor or fair health than college graduates, who live on average at least five years longer. Middle-class Americans on average die two years earlier than their wealthier counterparts, it found, and nearly one in three low-income people have chronic illness, compared with one in 10 adults in the highest income category.

Commission leaders said access to medical insurance is only a small slice of the health care puzzle. Lack of education, stress, barriers to regular exercise and healthy food and other socioeconomic and environmental factors play major roles in a person's health and life span, they said.

"While we must make health care delivery more efficient and broaden access to care, the medical system addresses only some of the factors influencing health," said commission co-Chairwoman Alice Rivlin, an economist at the Brookings Institution and visiting professor at Georgetown University. "There is more to health than health care."

Lead report author Paula Braveman, director of the Center on Social Disparities at the University of California at San Francisco, said "a chain of events" often is to blame for a low-income person's poor health. Poor education leads to low-paying jobs, which means living in unsafe neighborhoods and low-quality housing, having trouble affording healthy food, battling chronic stress from financial pressures, and having difficulty finding time to exercise.

The nonpartisan commission, which includes former Senate Majority Leader Bill Frist, will collect information and make recommendations. It aims to find and highlight unique and measurably effective programs run by small towns, businesses, faith-based groups and community organizations that improve education, nutrition, exercise and other key areas that affect societal health.

"There are a lot of really practical programs that businesses, local governments, faith-based groups are trying," said commission co-Chairman Mark McClellan, former administrator of Medicare and Medicaid. The goal would be to replicate such programs in communities nationwide, he said.

Mr. Frist, a heart and lung surgeon and a visiting economics professor at Princeton University, said with health care costs rising about 2.5 percent per year, lawmakers often look to the financing, organization and delivery of health care as the fix, when prevention is key.

"The way to [reduce the cost] is to lower the burden of disease in this country," he said. "People don't think in those terms."