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Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief (2023)

Chapter: Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief

Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
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images Proceedings of a Symposium—in Brief

Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All

Proceedings of a Symposium—in Brief


INTRODUCTION

On March 6 and 7, 2023, the Roundtable on Population Health Improvement hosted a two-day symposium at the National Academy of Sciences in Washington, DC. The event, Shifting the Nation’s Health Investments to Support Long, Healthy Lives for All, was designed to explore past calls for and the current state of efforts to

  • increase life expectancy;
  • eliminate excessive health care spending; and
  • invest equitably to create the vital conditions that all people and places need to reach their full potential for health and well-being.

The current state was compared both to the past as captured in two National Academies reports published one decade ago—U.S. Health in International Perspective: Shorter Lives, Poorer Health (2013) and For the Public’s Health: Investing in a Healthier Future (2012). The current state also was contrasted with what could be the future state, developing and implementing policies toward and investments in longer healthier lives for all people and communities. Ray Baxter, secretary of the CDC Foundation board and trustee of the Blue Shield of California Foundation, opened the event by acknowledging that the District of Columbia is the ancestral land of the Nacochtank and Piscataway people. He then provided brief background on the rationale and vision for the symposium and introduced facilitators James Whitfield and Kristen Whitfield of Be Culture and Fisher Qua of Back Loop.

The symposium featured 5 interactive sessions over 2 days: a keynote session (Anchoring in Curiosity), a gallery walk or mini poster-session (Showcasing What is Possible), a conversation with the National Academies volunteers who led the consensus committees that authored the two reports (Revisiting Two NASEM Reports), and a two-part dialogue about ideas for future directions (Amplifying a Movement for Longer, Healthier Lives for All).

ANCHORING IN CURIOSITY

During the first session of the symposium, three keynote speakers discussed the current state of public health, health care, policy, and health-related spending in the United States (see attendee packet for background material1). To frame the conversation, James Whitfield

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1 As indicated by background materials provided to attendees, including a brief synthesis paper reviewed. Refer to Meeting Materials on the event page https://www.nationalacademies.org/event/03-06-2023/shifting-the-nations-health-investments-to-support-long-healthy-lives-for-all-a-symposium (accessed April 3, 2023).

Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
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noted that the session would use an asset-based and appreciative inquiry2 approach. Following Whitfield’s introduction, Tiffany Manuel, president and chief executive officer of The Case Made, urged the audience to consider “the power of this moment” and cautioned against routinely accepting the status quo, stating, “We don’t want to be a wreck on a wreck.” She explained that there is plenty of data on and recognition of the nation’s shortcomings and challenges in health and health care, and there is a habit of repeatedly reciting the facts and issues, though little work gets done to address and prevent them. The fixation on the problems can make them seem overwhelming. Because of this, there is a need to shift the perspective to one that centers on ingenuity and achievement. As an example, Manuel discussed the COVID-19 vaccine rollout, which represented a time where national leaders worked together efficiently and effectively, health departments showed up with new capacities within their communities, and people helped each other in great ways. This type of story engages and excites people who will want to know what happens next, Manuel said.

Building on Manuel’s remarks, Anita Chandra, vice president and director of social and economic well-being at RAND Corporation, noted that in order for the nation to shift its perspective, it must frame its goals. First, the country must decide on a shared goal with respect to health. Second, it must decide if all its innovations truly translate to transformative change. Finally, it must consider the extent to which current solutions are too small and too narrow—in other words, has the United States missed an opportunity for a grander expectation for its work on health and the factors that create health? If the nation assessed where it currently stands, Chandra noted that there is both incredible concern and incredible optimism. There is reason to be optimistic that more people have come to understand that health is not the same as health care, and that there is renewed interest in taking a holistic approach to health and the possibility of integrating human potential into the public health conversation. Although the COVID-19 pandemic propelled some of these changes, Chandra questioned whether the nation has fully used the opportunity presented to it by the crisis. She asked the audience whether the conversations currently happening on big issues will add up to make a real difference in 10 years. This is where optimism meets the worry that the United States is missing “the forest for the trees,” said Chandra. To move the nation forward, she asserted, the full health potential of the country must be considered, new ideas must be supported and sustained, and vision and values must be declared and shared. In this, Chandra urged, “Let’s not make the conversation small. Let’s make it bold and grand.”

Dave Chokshi, clinical professor of medicine and public health at NYU Langone Health, reminded the audience of the significance of the worry at hand that “the decline in U.S. life expectancy is happening on our watch.” He expressed his concern that the nation lacks a greater sense of responsibility and accountability. To frame the nation’s goals as Chandra discussed, Chokshi suggested the need for new narratives where issues are communicated differently to the public. In his words, they must be “stickier” than current narratives like the zero-sum paradigm or the American dream, which are dangerous and unproductive, especially when juxtaposed with the reality of the U.S. population’s state of health and well-being. To demonstrate this new narrative idea, Chokshi gave the example of 16 million birthdays lost each year due to the country’s years of potential life lost. By framing the issue this way, the health disadvantage in the United States becomes more personal. “These are our grandparents, our children, our aunts and uncles, our neighbors who are not able to live their most fulfilled life because of that health disadvantage,” Chokshi said. Pointing to the power of narratives to shape policy structures, Chokshi asserted that when properly leveraged, they demonstrate that “we can do big things.” He highlighted examples from New York City’s response to the COVID-19 pandemic, such as mobilizing telemedicine, vaccinating 6 million New Yorkers, and providing unconditional cash transfers to medically and financially at-risk COVID-19 patients.3

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2 Appreciative inquiry is “an asset-based approach to organizational and social engagement that utilizes questions and dialogue to help participants uncover existing strengths, advantages, or opportunities in their communities, organizations, or teams” https://organizingengagement.org/models/appreciative-inquiry/ (accessed April 3, 2023).

3https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0149 (accessed April 10, 2023).

Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
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As she outlined the arc of the symposium and how the second session would build on the first by showcasing solutions, Hilary Heishman, senior program officer at Robert Wood Johnson Foundation, highlighted the nation’s fundamental need for more problem-solvers. To be bold and grand or to achieve big things, there is a need for people who are willing to work across sectors, develop solutions that can address multiple problems, and build solutions that are sustainable. Quoting Heather McGhee, author of The Sum of Us: What Racism Costs Everyone and How We Can Prosper Together, on the concept of the solidarity dividend4 (e.g., communities working together to find solutions for things they value) Heishman concluded her remarks by saying, “It is to our detriment that we leave out problem-solvers and their solutions.”

SHOWCASING WHAT IS POSSIBLE

The second session of the symposium featured a gallery walk, where several speakers presented models of what public and political will-building (using different strategies and at different scales) can achieve in changing the social and economic conditions for population health (see Box 1).

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Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
×
Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
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Whitfield called on Robert Kaplan, adjunct professor at Stanford University School of Medicine, to share reactions to the gallery walk. Kaplan shared that “we need different ways of quantifying and thinking about the impact of some of the things we do.” Decades ago, a paper he prepared for a NATO conference examined the indirect impacts of gun violence. Beyond the immediate figures on resulting deaths and injuries, Kaplan and colleagues tried to estimate the “cost of life loss associated with anxiety of being in a society where there are too many guns . . . It turns out, it comes out to be about the same as [the cost of] screening people for hypertension, something we very much agree we should do.”

As participants discussed how these policy approaches and models might be emulated and replicated on a greater scale, Pfingst shared that the Washington State government has never handled things perfectly and some of its work caused a lot of trauma, but government leaders solicited and received feedback from the community without defensiveness. By working closely with community members, leaders were able to build trust and move forward in an informed and productive way. As a steering committee member in this process, Bereskin noted that trust is fundamental; once it was built, she felt empowered to shift from being a client in the transaction to being a collaborator. Bereskin added:

In my community we are told to push forward together, and we can only be complete together. In order for us to do that, we have to understand us as people in poverty. We have the solutions everyone needs, and we also have to recognize we need to be in that same collaborative power and leadership because it cannot be a transaction—it has to be relational accountability and there has to be partnership and building of trust and understanding that our lived experiences have value. If we can take those experiences and create generational change, we have to do that.

Referring to the need to reframe how the nation looks at community health and approaches solutions, Chandra also highlighted that “We don’t tend to measure our ambitions and dreams, we tend to measure our deficits.” To move the conversation forward, Steven Woolf, emeritus professor at Virginia Commonwealth University, suggested beginning by aligning shared hopes, goals, and interests, especially with those who are traditionally excluded from the conversation. Building on Woolf’s statement, Jason Purnell, president of the James S. McDonnell Foundation, noted that the boundaries of the “in” group must be redrawn, and we must consider “What do we mean by ‘we’?” He added, “Equity does not happen on autopilot” but through deliberate choices and

Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
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changes. Tyler Norris, visiting scholar from the Federal Reserve Bank of New York, shared that the single largest contributor to the success of a program he worked on years ago to support 30 local communities were potluck dinners, saying, “Where is the trust? It’s in how we see each other…our wisdom traditions teach us to love one another as ourselves—not in some transactional way—but literally as ourselves to embrace this.”

REVISITING TWO NASEM REPORTS

The next session of the symposium featured Marthe Gold, professor emerita at the City University of New York, Steven Teutsch, adjunct professor at UCLA who led the committee that authored For the Public’s Health: Investing in a Healthier Future (the Investing report), and Steven Woolf, who led the committee that authored U.S. Health in International Perspective: Shorter Lives, Poorer Health (the Shorter Lives report). Atul Grover, executive director of the Research and Action Institute at the Association of American Medical Colleges elicited panelist perspectives on their reports’ focus and their reflections on the policies and investments mentioned or discussed in more detail during the poster sessions.

“What does the health care sector have influence over?” Grover asked. Because all levels of government have failed in multiple respects at social policy, he asserted, the health care delivery system is called on to “fix things.” He asked how the three panelists would characterize the problem and how they would identify the solutions to the problem. Gold said not only has the nation not achieved what was recommended in the 2012 report, the United States is still 2 years behind the average life expectancy among peer nations and spends twice as much per capita. A broader measure [of well-being rather than merely health] that is used internationally is Cantril’s Ladder of Well-being5 (a metric with 11 levels from Suffering, to Struggling, to Thriving). The term well-being may be more accessible and meaningful than health because people do not galvanize around health, Gold said. They care about it when they lose it, but by then it is too late to muster the energy to do something about it at a high level. However, people care about their job security, where they live, and how safe they feel. Considering this, health can be the anchor, but it is not what will help get people motivated and organized to take action, Gold noted. The 2012 report called for strengthening the nation’s measurement systems to help people understand how communities compare, how states compare, and how the United States compares to other nations, Gold said. Some of this has happened with the County Health Rankings and other measurement efforts, but the high-level measures of how the nation does and the deep disparities in health ought to become dinner-table conversation.

Teutsch highlighted how the COVID-19 pandemic demonstrated the shortcomings of the systems of data and measurement, as well as the inadequate integration between public health and clinical care information systems. The failure to strengthen the information system impaired the ability to respond to the pandemic. On a positive note, he added, the nation was able to move quickly to invest in families and in making payments to people in need, although the momentum for those supports is decreasing. It is a positive development of the past decade that the clinical care system asks patients about their social needs, but the health care system is less able at the moment to respond to those needs in a robust way. Partnerships and other changes will be needed to strengthen the response.

Woolf spoke about the U.S. Health in International Perspective: Shorter Lives, Poorer Health report’s charge to compare the United States to 16 other high-income nations. The findings at the time were that for every demographic and racial/ethnic group, the United States compared less favorably to peer nations, and, in addition to U.S. life expectancy being lower, the gaps were deepening even before the arrival of COVID-19. Americans between the ages of 25 and 64 have death rates that have been climbing since 2010, and this is only happening in the United States. Other countries have seen a decrease in life expectancy caused by the pandemic but on a lesser scale than the United States, and while the advent of the COVID-19 vaccines signaled a recovery in peer nations, the decrease in life expectancy has continued in the United States. Woolf echoed Gold’s call for transcending the concept of health for more

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5 See https://news.gallup.com/poll/122453/understanding-gallup-uses-cantril-scale.aspx (accessed April 10, 2023) and see additional discussion here https://nap.nationalacademies.org/read/25682/chapter/6#39 (accessed April 10, 2023).

Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
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accessible language on what needs to be improved in order to convince society and policy makers. He pointed to five distinctions between the United States and other wealthy countries made in the report:

  1. the structure of the health care system (universal access everywhere else);
  2. personal behavior (e.g., caloric intake, gun ownership, opioid use);
  3. economic and social factors shape personal behavior;
  4. the environment, both physical and social (including systemic racism), and how these affect health; and
  5. the domain of public policy—the macro factor that shapes the other four factors.

He added that he only wished the 2013 report had addressed more extensively the issue of systemic racism and its effects on health. For example, he noted in 2020 that the pandemic caused a loss of 1.2 years of life expectancy in 2020 for white people, but a drop of 3.4 years for Black and Hispanic people—a horrific loss. Woolf added:

There are 15 countries that have had higher life expectancy than the United States for 50 years. Repeat that: 15 countries have outperformed the United States for 50 years. They have figured this out. We know policies that could work, both that we can learn from other countries, and that we could develop innovatively, domestically, but promoting them, getting the political and public will behind that, I think is really where our focus needs to be.

Grover reflected on the American focus on personal responsibility and the eschewing of social policies that other Western democracies have embraced for a long time. He asked how the local messaging needs to be shaped. He also added that the consumption of health care services is comparable to similar countries, but it is the prices and wages (with a U.S. physician making three times their European counterpart) which set the United States apart. How can the messaging be consistent but also malleable and adaptable to different settings? Gold shared that the Roundtable on Population Health Improvement 2013 workshop on building a movement for health and health equity6 identified the need for an adversary to struggle against in order to energize people. How can racism and inequality be made apparent to help people move forward? Might art play a role in helping people come together to explore the problems of health and well-being with art exhibits, music, or plays?

Grover asked Teutsch how data could be helpful and why the data were such a challenge during the pandemic. Teutsch traced it to a confluence of factors including agency possessiveness about data, assumptions about regulatory limitations, and a bias for one’s own data systems. Leadership will be needed to move systems forward. At the local and regional levels, collaboration between public health and health care entities is showing promise and the potential for what can be achieved when people work together.

Gun homicides in the United States are four times the rate of the next country, and the United States also struggles with opioid overdose deaths, suicide, and other health crises, Grover stated. Given all of this, “How do we prioritize and how do we discuss the societal despair” from poverty, lack of education, and other reasons? In the medical and public health worlds, said Woolf, there is a tendency to think downstream too much and miss opportunities available upstream—the policies and investments that distinguish the United States from its peer nations. How can the public and policy makers be convinced of the reasons behind people feeling stuck and unable to see a future for their children? The solutions to those issues cannot be branded on data and on “improving population health” (i.e., on technical information and language). He emphasized that, as Manuel shows through her work on framing, and as illustrated in such advertising campaigns as Subaru’s, advertisers appeal to consumers indirectly. The tag line for the automaker’s commercials is that “Love makes Subaru, Subaru.” That framing, Woolf asserted, “has nothing to do with the performance of the cars, safety

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6 The workshop publication is available at https://nap.nationalacademies.org/18751 (accessed April 4, 2023).

Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
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ratings, gas mileage. It is how to package a message in a way that speaks to people.” People with expertise in narrative and framing can help the field improve its messaging.

AMPLIFYING SIGNS OF A MOVEMENT FOR LONGER HEALTHIER LIVES FOR ALL, PART I

In the final, two-part session of the symposium, one of the virtual participants was invited to speak. Former U.S. Surgeon General Jerome Adams, currently executive director of Health Equity Initiatives at Purdue University, shared some thoughts on health equity, the role of payment reform toward value, and the importance of having the right messengers shape the narrative on health to move policymakers. He stated that equity is not about giving everybody the same thing but giving people what they need. In addition, he reflected on an expansive concept of equity that includes attention not only to race and ethnicity but also to people in rural areas and to veteran populations and their needs. Adams asserted that equity is also about quality, that disparities are in part about people not getting the same quality of care, and that it is necessary to appeal not only to people’s hearts but also to their heads and wallets through pragmatic, “what’s in it for me” questions and economic arguments. Drawing on his work developing the first Surgeon General’s report on the role of business, Community Health and Economic Prosperity, he underscored the understanding that health care is not the same as health—in fact, it accounts for only 20 percent of what makes health—and emphasized working with business leaders to convey the messages about health and health-promoting policies.

Following Adams’s remarks, the symposium facilitators invited a set of panelists to start the conversation about how communities, organizations, and others could move forward seizing the opportunities available at this moment, building the infrastructure, and spreading and scaling up proven solutions, and amplifying powerful narratives.

Martha Sanchez, director of health policy at Young Invincibles, described how the organization started as a group of college students advocating for young people being able to stay on their parents’ health insurance up to the age of 26, something that became part of the Affordable Care Act. That policy solution emerged in response to a slow-growing crisis of people without health insurance. Young Invincibles is a kind of wordplay on a truism that young people may feel invincible, but, she noted, are not doing so well: they are in crisis. More recently the group has been working on issues at the interface of health and well-being—such as paid leave and student loan forgiveness. Referring to a phrase used earlier in the day, Sanchez stated, “Maybe we’re not calling it well-being, we’re calling it self care.” How does one bring to the attention of Congress the story of a young person on TikTok venting about not being able to afford therapy for a mental health issue, she asked, adding, “When you think of movements, they are usually led by young people. We must include them in these conversations and invest to make sure we are able to amplify their voices.”

Somava Saha, executive director of WE in the World and executive lead of the WIN Network, outlined the conceptual and narrative shifts of the past decade, from thinking about health care to thinking about health, and putting the public back in public health through a growing movement of community engagement and leadership in building the conditions for health and well-being. Creating a new narrative about health depends on recognizing that this is about love and care for one another, she added. Saha shared brief highlights from the work of hundreds of organizations that are designing and implementing “brilliant solutions,” describing it as the blossoming of an ecosystem or infrastructure with connected people and organizations, from barbers and beauty salon owners to health departments. She told the story of a Black artist who was concerned about COVID-19 vaccines and the misinformation about them. She and artist collective Chromatic Black launched the multi-faceted Keep Black Love Alive6 effort to embed factual vaccine and public health information in a much broader story-telling project.

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6https://www.keepblacklovealive.org/ (accessed April 10, 2023).

Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
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Tyler Norris shared highlights from his three decades of supporting and leading a variety of movement-oriented efforts, from the Healthy Communities movement funded by the U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion with inspiration by the European Model Cities approach, to the Build Healthy Places Network, to the work at Kaiser Permanente, and more recently at Well-Being Trust. Norris paraphrased Alexis de Tocqueville, reflecting on Americans being able to devise solutions as a reminder that the nation has the resources and the knowledge that are needed: “We have all we need, we are blessed with abundance.” He emphasized that “If you brought a diverse and thoughtful group of people together they could identify their values and create a vision of the future, and given the opportunity, the communities would get things done, would put themselves on the line for it because they were already ‘in the kitchen.’” Given all that is known and all that has already been done and learned, he asked, how can “principles of community level movement building” be brought to scale? He shared that his experience at Kaiser Permanente taught him that the effort had to be “all in.” The organization had to focus on community benefit spending and ensuring its investments had enough reach, intensity, and duration—that is, enough dose—to have an effect at the population level. Soon, Kaiser Permanente learned that it needed deeper partnerships, intensity, duration, and reach to be able to start seeing an effect. It came to see that beyond community benefit, the purchasing power of health care organizations as anchor institutions dwarfs the grantmaking, as does the payroll and the investment portfolio. “How do all these become deployed [to achieve the desired effect]?” he asked. “When you know what you’re doing doesn’t add up—not sufficient dose, not an anchor, not connecting to the community—it’s unethical to continue doing it that way,” Norris said.

Tiffany Manuel revisited her opening comment about a sense of heaviness in thinking about the fact that people have been systematically denied what they needed to thrive and about the cost of the millions of birthdays lost. She spoke of the need to connect to the aspirations of people, to talk to young people in the language, technology, and spaces they use.

Following a round of small group discussion, the facilitators called for audience reflections. Pfingst remarked that it is hard to operationalize the solidarity dividend in narratives and across different spaces. She remarked on how power operates and how it needs to be shared. She said there are “a lot of leaders who themselves don’t think they have time to listen to the steering committee members” (i.e., members of the community) but, in reality, “all leaders need to listen to the people [they] profess to serve.”

AMPLIFYING SIGNS OF A MOVEMENT FOR LONGER HEALTHIER LIVES FOR ALL, PART 2

On the second day of the symposium, speakers and attendees continued the conversation from the previous afternoon. Facilitator James Whitfield opened the session, sharing a reflection he had with a group of attendees on the topic of equity. “Equity is shared ownership where there are multiple owners,” he said. Whitfield then used the example of one’s equity in a company, noting that when a person “buys into a company,” they participate in setting the direction of that company and reap the benefits of that shared ownership. In addition, that company increases its worth. He noted that the same is true of health equity, though there is a common misconception that advancements for certain populations result in losses for others. Equity is additive every time, stated Whitfield, echoing Heishman’s earlier reference to the solidarity dividend. When more people buy into an idea, it increases the value of it, Whitfield explained, and in order for health equity to work, everyone must buy into and contribute to it. In doing so, everyone will experience its benefits in society; however, to achieve that, health equity first requires a shared ownership over a definition of success, as well as a shared ownership over the challenges and barriers to that success.

Norris asked the audience to think about what or who is at the center of the work that is being discussed, and he shared his view on the centrality of children, the importance of committing to “caring for our children.” Sanchez reflected on her own identity, on her family’s

Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
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immigrant experience and the movement for immigrant rights that, she noted, has stalled. Every time that people, especially young people, organize and put their lives on the line, it is important to ensure that the work will succeed. Sanchez said that there are young people who still believe in this country and its democracy, and for their sake, it is crucial to embrace this moment for health, social justice, and civic engagement. “The brilliance of youth is that you don’t yet know . . . you haven’t been talked out of your passion yet . . . . I think we as adults have fallen down,” added Manuel. She said that the course of life in this country wears people down, and that “we must operationalize our democracy to benefit everyone.” However, to do so, it will take work, Manuel said. She explained that democracy is taught as an accomplishment made in 1776, not as an ongoing process that requires continuous work.

Saha spoke of growing up in an immigrant household and witnessing the incredible opportunities in the United States as a child but also the incredible pain it allowed many of its citizens to endure. Saha said she grew up conflicted as both the opportunity and the pain were true of the America in which she lived. “How serious are we? Every system is perfectly designed to obtain the results that it gets, and we are the system. This is happening on our watch,” Saha said, echoing Chokshi’s remarks. “What does it mean for our love of our neighbors to be strong enough to cause us to cede some ground, some ownership of the process and the outcomes so that we can have so much more together?” Saha asked. She added that the groups whose leadership was absent in the room—local communities, people with lived expertise—need to be part of creating that change.

Online attendees contributed their reflections. Willa Truelove, Beverly Rogers, and Ramey Wood expressed concerns about the lack of action taken to address the health and equity issues discussed during the symposium. They each stated in different ways that these conversations have occurred multiple times in many settings where the conversation is energized, yet people leave and nothing happens; ordinary people continue to suffer. Rogers spoke of herself, stating that she is an older Black woman in a senior community where resources are scarce. Moreover, Wood, who lives in Alaska, explained that he sees the neglect of Native American communities and land, and little is done to help.

Bereskin shared “I’m going to go home, and I’m still going to be suffering after this.” As a member of the steering committee to the Governor’s Poverty Reduction Work Group, Bereskin advises on health equity efforts for indigenous communities in Washington State, and she does this with the experience having lived for 38 years in poverty. She said professionals, leaders, and people in power must decide what to do and to make real changes because the issues discussed throughout the symposium affect real people like herself. Bereskin said, “If you’re in a position of power and privilege and influence, how are you going to be able to use that to uplift our people . . . and recognize that for our community, we don’t make friends, we make relations.” She added, “For us, in our community, greed was a crime . . . . if you were greedy, you were going to kill your entire community.”

Marc Gourevitch, chair of the population health department at NYU Langone Health, remarked on the difficulty of answering “what is the what” that the conversations transformation and mobilization were coalescing around, but he underscored Manuel’s observation about the need to build public and political will. Heishman reframed the question Gourevitch asked as, “What needs to be woven together? What needs to be lifted up and powered so that we can start to add up, [and] build movement toward this sort of future that we are imagining together in which all children are able to reach their full potential?” referring to a goal that arose repeatedly in the course of earlier discussion.

The conversation continued with an exploration of ideas for future directions, from organizations and sectors to infrastructure and tools. Kaplan cautioned, “We’re making the assumption that we have the answers to some fairly complicated problems.” He questioned if the right people were even in the room to approach a solution or decision. Pfingst added that those who are

Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
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not part of the conversation are the people with answers that have not been considered.

Martha Sanchez spoke about the diverse coalitions that mobilized on Medicare issues to illustrate a broader point about what is needed to drive policy change. She noted that there are two components to the work of building and sustaining a movement: an “army of advocates” and a “whole other army that needs to be there to get them across the finish line, which is equipping them with strategy, with appropriate messaging, with access, and financing them right.” Saha agreed and said that work requires infrastructure for change and for movement building and investments in a common infrastructure that aligns all interests such as those of people who care about the child tax credit and those who care about direct cash payments—just to name two of the policy solutions being discussed.

Chandra then suggested the audience consider the “slivers of daylight that undermine the North Star.” She explained that the field has been distracted by all the data and information on the topic at hand. While these are necessary and important, it is not productive to fixate on the research and repeatedly discuss it rather than actively implement proven solutions to address the problems. Chandra expressed that by persisting in this vein, people working on these issues may be making things more complicated than they need to be. She then acknowledged that there is a fundamental issue in a lack of shared vision and solidarity, even within the room, noting that given the variety of perspectives “There is just a little enough difference [among different viewpoints] such that you could drive a truck through it.” Bobby Milstein, director at ReThink Health, shared that people who are interested in this work have two important ingredients of what is needed to move forward:

One is the attention, and the other is the discipline and communication to be able to lead with things that will bring other people to join this work, which may mean giving up the analysis and the strategy and talking about what could and should be, to [instead] lead with things that could actually pull other people in.

Ray Baxter reflected on the ability of the partnerships and networks in the orbit of the Roundtable on Population Health Improvement and acknowledged that although those efforts are not the movement or “in the movement field,” they can “help mobilize people in the fields that we are in.” Ray noted that “We have an opportunity to reach the people and organizations and voices . . . who could be mobilized.”

Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
×

DISCLAIMER This Proceedings of a Symposium—in Brief has been prepared by AYSHIA COLETRANE and ALINA B. BACIU as a factual summary of what occurred at the meeting. The statements made are those of the rapporteurs or individual workshop participants and do not necessarily represent the views of all workshop participants; the planning committee; or the National Academies of Sciences, Engineering, and Medicine.

*The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Symposium—in Brief rests with the institution. The symposium was planned by MARCELLA ALSAN, Professor of Public Policy, Harvard Kennedy School; ANITA CHANDRA, Vice President and Director of Social and Economic Well-Being, RAND; ATUL GROVER, Executive Director, AAMC Research and Action Institute; DORA HUGHES, Chief Medical Officer, CMS Innovation Center; HILARY HEISHMAN, (Chair) Senior Program Officer, Robert Wood Johnson Foundation; TIFFANY MANUEL, President and CEO, The Case Made; MAC MCCULLOUGH, Associate Professor in the School of Public and Population Health, Director of Public Health Agency Partnerships, School of Public and Population Health, Boise State University; BOBBY MILSTEIN, Director, ReThink Health; TYLER NORRIS, Visiting Scholar, Federal Reserve Bank of New York; KARA ODOM WALKER, Executive Vice President and Chief Population Health Officer, Nemours.

REVIEWERS To ensure that it meets institutional standards for quality and objectivity, this Proceedings of a Symposium—in Brief was reviewed by SHERI JOHNSON, University of Wisconsin–Madison and PAUL HUGHES-CROMWICK, PHC Health Care. LESLIE SIM, National Academies of Sciences, Engineering, and Medicine, served as the review coordinator.

STAFF MAGGIE ANDERSON, Research Assistant; ALEXANDRA ANDRADA, Program Officer; ALINA B. BACIU, Roundtable Director; AYSHIA COLETRANE, Senior Program Assistant.

SPONSORS This workshop was partially supported by Atrium, Association of American Medical Colleges, Blue Shield of California Foundation, Fannie Rippel Foundation, Kresge Foundation, Nemours, NY Langone School of Medicine, Robert Wood Johnson Foundation, Saint David Foundation, Samueli Foundation, and The California Endowment.

For additional information regarding the workshop, visit https://www.nationalacademies.org/event/03-06-2023/shifting-the-nations-health-investments-to-support-long-healthy-lives-for-all-a-symposium.

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2023. Exploring policies, investments, and case-making for longer, healthier lives for all: Proceedings of a symposium—in brief. Washington, DC: The National Academies Press. https://doi.org/10.17226/27010.

Health and Medicine Division

Copyright 2023 by the National Academy of Sciences. All rights reserved.

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Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
×
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Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
×
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Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
×
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Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
×
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Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
×
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Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
×
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Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
×
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Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
×
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Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
×
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Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
×
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Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
×
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Suggested Citation:"Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium - in Brief." National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/27010.
×
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A decade ago, two National Academies reports — U.S. Health in International Perspective: Shorter Lives, Poorer Health and For the Public's Health: Investing in a Healthier Future — made important recommendations regarding the nation's health and the policies and investments that shape it. They also aimed to raise alarm about the public's lack of awareness that the nation's unrivaled spending on health care is not matched by health outcomes and appears to be worsening.

Although experts know what factors support longer and healthier lives and close health gaps along lines of race and ethnicity, the nation falls short in implementing policies around those factors or investing in needed system changes and interventions to address them (e.g., equitable education, poverty reduction). The National Academies' Roundtable on Population Health Improvement hosted a March 2023 symposium to explore innovative policies addressing poverty and other socio-economic factors and next steps toward more balanced spending on health.

This proceedings document summarizes symposium discussions.

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