One smart upstream investment

From Politico: The Agenda 2020

Our 14 public health all-stars offer their top ideas for reshaping America's long-term health

It’s hard enough for most of us to make smart long-term plans. It’s really hard for politicians to do it. So a year ago, at the beginning of our Agenda2020 series on the deep future of American health, we pulled a group of experts into a room in Washington and asked them: If we want to improve the health of a changing nation, what would you do?

Overwhelmingly, they converged on one big message: Health isn’t just about health. Real improvements in the national health – the kind that increase our average lifespan, boost our prosperity, and maybe even bend the curve of escalating costs – depend on connecting a whole network of services and life influences. They also take decades, meaning that if we want a healthier America not just in 2020, but in 2040 or 2050, we need to make some big decisions now.

So what should we be focusing on? To wrap up our yearlong series, we returned to our panel of experts, as well as a number of others who have contributed to our series over the past 12 issues, for one big idea. If Washington could invest in one “upstream” factor – one big commitment to shape the future of national health – what should it be? Their answers ran the gamut, from a bold new attack on child poverty to a better vision for elder care to a “foresight fund” that would prioritize the kind of investments politicians have trouble making.

Break down structural racism

Tyson Brown is an assistant professor of sociology and director of the Center for Biobehavioral Health Disparities Research at Duke University. His video for Agenda 2020 on how racial and economic disparities affect health can be seen here.

The most important decision we can make today to improve population health tomorrow is to address structural racism and its harmful health consequences. Structural racism—i.e., the systematic exclusion of some people from resources and opportunities on the basis of their race—limits access to health-promoting resources for racial minorities, such as good schools and jobs, healthy communities and quality health care. It also increases their exposure to factors that are harmful to health, such as chronic stressors, discrimination, and incarceration. These processes generate dramatic racial inequalities in heath in the U.S. and result in unnecessary suffering, premature mortality and excess economic costs of over $300 billion annually.

Reducing structural racism and racial health disparities will require bold actions, but these actions can take the form of cost-effective, race-neutral policies that would improve overall population health. For example, policy initiatives such as the Child Trust Account Program, Federal Jobs Guarantee, Criminal Justice Reform, and the enforcement of the Fair Housing Act would reverse the rising tides of economic and social inequality that are undermining our nation’s health. These policies would disproportionately benefit communities of color and go a long way toward achieving health equity, while at the same time improving the health of the U.S. population as a whole.