Commission to Build a Healthier America

The Robert Wood Johnson Foundation's Commission to Build a Healthier America today released 10 cross-cutting recommendations for health system reform.

Nutrition and physical activity were featured in the recommendations, with at least as much emphasis as medical care.

Among the Commission’s key recommendations are:

• Give kids a healthy start. Ensure that all children, especially very young children in low-income families, have high-quality education and child care. This means increasing federal government spending to support early childhood development for young children in low-income families. This recommendation is critical, because evidence is now very strong that early childhood has a tremendous impact on a person’s health across a lifetime.

• Ban junk food from schools. Feed children only nutritious foods in schools. Federal funds should be used exclusively for healthful meals.

• Get kids moving. All schools (K-12) should include at least 30 minutes every day for all children to be physically active. Although children should be active at least one hour each day, only one third of high school students currently meet this goal.

• Help all families follow healthy diets. More than one in every 10 American households lack reliable access to enough nutritious food. Federal supplemental nutrition programs should be fully funded and designed to meet the needs of hungry families with nutritious food.

• Eliminate so-called nutrition deserts. Create public-private partnerships to open grocery stores in communities without access to healthful foods. Many inner-city and rural families lack this access; for example, Detroit, a city of 139 square miles, has just five full-service grocery stores.

“For too long we have focused on medical care as the solution to our health problems, when the evidence tells us the opposite,” said RWJF President and CEO Risa Lavizzo-Mourey, M.D., M.B.A. “We must make it possible for more people to make healthy decisions and avoid getting sick in the first place. The Commission has provided us with a principled, sensible and experience-driven blueprint. We cannot afford to wait to implement these recommendations.”

The Commission sought to sidestep traditional political controversies in health policy by addressing both the personal and the political aspects of health care.

“Everyone must be involved in the effort to improve health because health is everyone’s business,” said Co-chair Alice M. Rivlin, former head of the White House Office of Management and Budget and the first director of the Congressional Budget Office. “People should make healthy choices by eating better, getting enough physical activity and not smoking. Communities and employers should support those choices by creating healthy environments. And the federal government should make and enforce healthy policies, like ensuring that all subsidized food is healthy and junk food is eliminated from schools.”

As part of the Commission's information gathering, I participated in a panel last Fall that provided information about food and nutrition assistance programs. Sheila Burke, one of the Commissioners, summarized:

This Commission has been charged with finding solutions outside the traditional health care system to improve the health of all Americans. Nutrition policy is an important place to start.

In the current economic climate, there is no question that demand is growing for the food benefits and nutrition education offered by programs like SNAP, NSLP and WIC. As part of the Commission’s fact finding, I had the honor of convening some of this country’s top experts on nutrition policy to address how we can use and further develop these powerful levers to improve the health of Americans quickly, directly and sustainably.

The group acknowledged that FNS program policies, such as the composition of school lunches, should be set based on sound nutrition research. The good news is that there is a growing consensus about what these nutrition standards should be. The challenge – for advocates and policymakers at all levels – is addressing the funding constraints that impede these programs from achieving the highest nutritional standards. It is clear in many cases that these programs are underfunded at a time when demand is increasing.

What struck me most was that everyone around the table – academics, advocates, federal program administrators and others – shared a commitment to finding the best way to manage these programs and get individuals the support they need in these challenging times. This shared vision is key. Achieving better health through better nutrition is not just a Federal responsibility—it requires the commitment of school districts, grocery stores, communities, and state and local governments.