Q&A with Trust for America’s Health’s Jeffrey Levi: ‘Everyone has a role to play’ to improve health

February 7, 2012
The Nation's Health

A federal effort to shift the nation from its present sick care system to one focused on prevention and wellness went into motion in June with the release of the National Prevention Strategy. The strategy, developed by the National Prevention, Health Promotion and Public Health Council, calls on federal agencies and private and public partners to work together to implement evidence-based recommendations aimed at improving the nation’s health. The council is guided by the 13-member nonfederal Advisory Group on Prevention, Health Promotion and Integrative and Public Health, which is chaired by Jeffrey Levi, PhD, executive director of Trust for America's Health.

Public health leaders see the National Prevention Strategy as an unprecedented effort to move prevention to the forefront of the nation’s work to improve health. Why did it take so long to take this step?

The Affordable Care Act in general gives prevention a much higher priority, both in the clinical setting with first-dollar coverage of certain preventive services to the creation of the National Prevention Council and the mandate for it to issue a National Prevention Strategy, to the Prevention and Public Health Fund. All of that comes from a recognition that the biggest cost drivers in our system today, which are chronic diseases, are best prevented, and to some degree controlled, outside the clinical system. In a sense, if we want to bend the cost curve and improve health outcomes, we have to do the kind of prevention that’s envisioned in the National Prevention Strategy. That’s a very important recognition that every agency of the federal government has a federal role, whether it’s Housing and Urban Development, or Transportation or even Homeland Security or the Department of Justice. Building more accessible communities, building more economically vibrant communities, having safer communities — all of those contribute to health. And so everyone has a role to play and that’s the exciting part, not just of the prevention strategy, but the ongoing work of the National Prevention Council, to apply a health lens to so much of the work that federal agencies do.

You chair the 13-member nonfederal advisory group that guides the National Prevention, Health Promotion and Public Health Council, which developed the strategy. What are the group’s top goals?

We have two primary goals. One is to assist in the implementation of the National Prevention Strategy so that this notion of applying a health lens to all policies really becomes part of the culture of the federal government. A second goal that we all have as individual advisory group members is to bring the message back into our communities about the value of the prevention investment in the Affordable Care Act. There has been so much noise around the Affordable Care Act and political controversy. The American people overwhelmingly support prevention, whether it’s clinical prevention or community prevention. I think the challenge here is letting people know how much of value around prevention is in the Affordable Care Act and break through all the dissonance that surrounds the (act) right now.

The National Prevention, Health Promotion and Public Health Council brings together the cabinet secretaries and directors of 17 federal departments and agencies. Why are these leaders key to the strategy’s success?

The National Prevention Strategy recognizes that we need to not just be addressing the consequences of poor health but also addressing the social determinants of health. We are not going to be healthy if we don’t also address poverty issues, housing issues, education issues. We know that people who have better jobs or higher incomes are healthier. We know that people who are better educated are healthier. We know that people who are better housed are healthier. Those are just a few examples, but every federal agency can contribute to creating better health. We are not just talking about things on the margins and we are not just talking about health-specific behaviors, but we are also talking about the social determinants of health. That’s what’s exciting — that all of these agencies have come to recognize that they have a role to play and that their core business is about health. We’re not just asking these agencies to embrace certain policies because they are good for health. We are saying to them: “Your core business affects health, and so doing your core business better will result in improved health outcomes.”

How can federal agencies and private and public partners work together to help implement the National Prevention Strategy’s recommendations?

The surgeon general and the advisory group are taking the prevention strategy on the road (for) a series of regional meetings. The goal here is to try to catalyze a replication of the kinds of relationships that are being formed at the federal level through the National Prevention Council — replicate those at the state and local level. So we need coalitions formed. We need the federal agencies doing their work in particular communities to be better coordinated. But we also need health departments, the business community, local chambers of commerce, education programs, housing programs — all of them to come together and determine what in their community can be done to replicate the kind of collaboration that’s implied in the National Prevention Strategy. In fact, the National Prevention Strategy makes clear that it is national, not just federal. So it’s not just what federal agencies can do but what every sector can do.

The council’s annual status report is due by July 1. What can we look forward to?

You are going to see an outline for an implementation strategy and a real determination to show by July 1 that specific steps have already been taken in a number of the agencies to begin to implement the vision of the National Prevention Strategy.

In your opinion, what is the most serious health issue facing the nation today?

Probably the most serious problem we face is this epidemic of insufficient physical activity and poor nutrition, which leads in turn to obesity and lots of chronic diseases. And those chronic diseases are driving the high demand on our health care system and also driving health care costs. That’s what we need to address, and we need to do it in a comprehensive way so that healthy choices become the easy choices and people embrace a more active lifestyle.

What role do state and local health departments play in addressing these health issues?

Health departments need to become conveners and need to bring together the key players in a community — that means the business community, the local chambers of commerce, large employers, the education community, the public safety community — anyone who can have an impact on the health choices that people are going to be making. And so that convening role becomes incredibly important. But it’s more than a convening role. Health departments bring a level of expertise about the evidence of what works and need to share that expertise with these other new players in the game. 

How would cuts to the Prevention and Public Health Fund impact work to curb chronic disease?

The Prevention and Public Health Fund is sort of our leading edge in supporting transformative approaches to prevention and to support the modernization of our public health agencies. If those funds are cut, that will have a dramatic impact on our ability to respond not just to chronic diseases but to any kind of threat or health issue that our communities face. The biggest loser here, so to speak, would be the Community Transformation Grants, because they are funded entirely through the Prevention and Public Health Fund. But also new investments that the federal government is making in helping state and local health departments improve the quality of their work and expand their ability, for example, to deal with electronic lab reporting and build lab capacity — those kinds of programs would be cut. One of the challenges we have here is that while the prevention fund represents new money, the base in funding to public health agencies such as (the Centers for Disease Control and Prevention) and (Health Resources and Services Administration) is being cut in some instances. The prevention fund was never meant to be a gap-filler but instead was supposed to build on a very strong base. And so we are seeing a diminishment of the core capacity of health departments even as new responsibilities from the prevention fund are being added on. It’s a real challenge to keep your eye on modernization and improvement of new programs when a lot of your core capacity is being undermined.

·         Copyright The Nation’s Health, American Public Health Association

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