Where We Live Can Effect Overall Health, Success

WASHINGTON — GW Health Policy Researchers, led by Wilhelmine Miller, Ph.D., associate research professor in the School of Public Health and Health Services, Department of Health Policy, played a major role in the supplement of the American Journal of Preventive Medicine (AJPM), funded by the Robert Wood Johnson Foundation (RWJF). The Supplement outlines the fundamental understanding of the fact that where we live, learn, work and play has much to do with our health as the health care we receive. It builds on the work of the Robert Wood Johnson Foundation’s Commission to Build a Healthier America, which was charged with exploring how factors outside the health care system impact health and crafting recommendations to improve the health of all Americans.

Dr. Miller, who served as the associate director of the RWJF’s Commission to Build a Healthier America, was the lead author on two articles, and co-authored two others, in addition to serving as the guest lead-editor for the supplement. She and the other authors explored the evidence and rationale for the Commission’s 10-recommendation blueprint for action. The articles address factors ranging from early childhood education, to homes and communities, to the economic rationale for improving the lives of Americans.

“Wilhelmine’s contributions have expanded our ability to help people to thrive by identifying issues that can be a barrier to health and helping people to learn how to protect their health. The work of Dr. Miller and her colleagues will have a positive impact on the daily lives of people in our communities,” said Dr. Lynn Goldman, Dean, The GW School of Public Health and Health Services.

Dr. Miller authored and co-authored the following articles that are included in the supplement:

o The article titled, “Healthy Starts for All: Policy Prescriptions,” is a review of child health and development research from the past 20 years and it offers a brief synopsis of current knowledge. The authors updated information and identified evidence-based policies and interventions. The paper describes interventions undertaken to improve cognitive, social and emotional development, in particular for socioeconomically disadvantaged children. The authors reviewed the different types of childhood stress and report recent increases in federal funding.

o The article titled, “Citizen-Centered Health Promotion: Building Collaboration to Facilitate Healthy Living,” focuses on the Commission’s research that found that health improvements that rely on personal behavioral changes are best supported by community-based efforts in tandem with clinical prevention. Researchers found that reductions in tobacco use have come from public policy and cultural changes rather than education campaigns about tobacco's health risks, and obesity has a greater relationship to socioeconomic status than to whether individuals are educated about exercise and nutrition. The authors critique the common assumption that unhealthy behaviors are solely the product of individuals' unhealthy choices, and argue that effective interventions must address the environmental opportunities and obstacles that shape health behaviors.

The authors found that the challenges to implementing a citizen-centered approach to improving health behaviors include long-term financial sustainability; the development of infrastructure to connect disparate community entities; and how to prioritize health behaviors.

o The article titled, “Healthy Homes and Communities: Putting the Pieces Together,” supported the work of the Commission, finding that creating healthier community environments requires working with housing, transportation, recreation, community development and planning partners, as well as with the private and public sectors.

In order to implement the Commission's recommendations, the authors suggest including public, private, voluntary and philanthropic investment and incentives for investment in community-based prevention. They also recommend that community foundations and local businesses and employers formulate and participate in health initiatives.

The researchers found that continued evaluation of community-based interventions is needed to provide more evidence of the interventions' impact and to guide future policy and investments.

o The article titled, “The Economic Value of Improving the Health of Disadvantaged Americans,” is based on the 2007 RWJF-commissioned analysis finding that the cost of higher mortality rates and poorer health status are associated with lower educational attainment. Assuming that a year lived in optimum health is valued at $100,000, if all groups with less than a college degree were brought up to the same mortality rates as those with a college degree, the gain was valued at $493 billion. Bringing the health status of the less educated up to those with a bachelor’s degree would create a benefit of $527 billion. Together the benefits of decreasing health disparities associated with educational disparities were valued at $1.02 trillion per year.

"By expressing the health disparities in monetized form, the magnitude of the disparities can be more easily compared with other policy priorities," the researchers write.

About the George Washington University School of Public Health and Health Services:

Established in July 1997, the School of Public Health and Health Services brought together three longstanding university programs in the schools of medicine, business, and education that we have since expanded substantially. Today, more than 900 students from nearly every U.S. state and more than 35 nations pursue undergraduate, graduate, and doctoral-level degrees in public health. Our student body is one of the most ethnically diverse among the nation's private schools of public health.

About the Robert Wood Johnson Foundation:

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years, the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime.