New Blood: Thankfulness Amidst Challenges to Ideal US Health Reform

It seems that most people are unhappy about the current status of the health reform. Concerns are growing that the Senate bill will stimulate a large increase in premiums for everyone, while still leaving holes by which insurance companies can drop coverage on certain patients.

In total, for all the wrangling and political capital spent, it seems that an opportunity may be missed to introduce some uniformity into our fragmented system. It's estimated that over ten million people will still remain uninsured even after the reform, and navigating the complex health care system will be little easier than it is now for most Americans. While the country decided that construction and maintenance of the most advanced highway system in the world should not be the individual responsibility of you and I (in large part because the highway system was necessary for military functions), it seems we are still deeply split on whose responsibility preventing, or treating sickness, should be. Ultimately, you'll still have to fend for yourself, if you want to keep yourself as healthy as you can be, or get the best possible care when you need it.

Stepping back for a moment, however, I want to share this anecdote. Earlier this week, I was speaking with a friend in Bucharest, Romania. Romania is not the country we all think of from the days of the Iron Curtain, but rather a rapidly developing member of the European Union where, in Bucharest, it can be as much to rent an apt as in NYC these days. A relative of his wife had an aneurysm which ruptured. Without a basic blood transfusion, he would have died. In order to save him, my friend had to round up people from his office to come to the hospital and donate blood on the spot, till the hospital could find a match.

In our country, no matter how difficult the medical billing, no matter the challenges you have with scheduling, when you need a blood transfusion, you will almost always get one. Like the highways, the collective of our country decided there should be a national system Blood Banking system, led by organizations like the American Red Cross, who work hand-in-hand with government at multiple levels.

No one is going to be entirely happy with America's Affordable Health Choices Act. In a country and states that cannot even replicate the construction and operation of high speed rails you can find in Asia or Europe, how could anyone expect that this bill could be anything more than a compromise, that is iterated over time? The pros of a compromise are that it's less likely to create severe damage compared to a more decisive experimental approach; the cons-- it has no hope of fixing ALL the problems on its own.

Like the Red Cross did for Blood Banking in tandem with government, citizens, social entrepreneurs and larger organizations will need to continue to innovate new systems to improve the Delivery of health care, and Prevention, which move beyond the walls of hospitals and clinics, back into the community and the home. Regardless of the flaws that will inevitably remain in this health insurance reform bill, it will still create some basic improvements rooted in justice and equity:

--Difficult to exclude coverage for people based on pre-existing illnesses, which are sometimes uncontrollable-- i.e. fully or partially genetically based.
--Shifting of resources to, and reimbursement of prevention and wellness, meant to keep the population at large healthy, and reduce long-term care spend.

When considering how disappointed you might feel about the health reform legislation to date, ask yourself if these are two wins you agree with, and can get behind. Ask yourself if you appreciate the fact that if you or your child bleeds out, another person has already put his/ her blood on loaner for you at a hospital nearby. Then, rather than voicing a complaint devoid of a helpful alternative suggestion, hunker down and keep working on systems and policy innovations to create a delivery system for health and wellness that will obviate the need to keep supporting the reactive care system we have in place today. One beautiful thing among all the ugly things about our legislative system, is that you can keep introducing New Blood into the legislation, to improve upon the gaps and mistakes of the past.

Ensuring inclusion of health education and healthy behavior facilitation in the Health Care Reform Bill

The introduction of the upcoming health reform legislation promises to include a strong set of reforms for building a new infrastructure for prevention and healthy lifestyles in the US. As the bill progresses, it will be critical to provide your support to maintain these prevention items in the legislation. Under duress to cut costs of the bill to pass large scale insurance and access reforms, investments in health education and children's wellness may suffer first. But, if we truly want to stem long-term costs by preventing obesity, chronic disease and suffering of the future, advocacy to prevent this, will be critical. There are a number of ways to maintain a focus on prevention and wellness in the legislation. Here, I focus on:

•Health and physical education (at least weekly education on healthy behaviors and understanding of the human body/ self awareness)
•Facilitation of sixty minutes of daily physical activity (recess, gym, sports) and healthy nutrition (breakfast, lunch, snacks)

Unlike previous measures, new legislation should specifically identify standards schools should follow and report on, such as fulfilling the CDC guidelines for physical activity.

------------Specific Language Suggested for the Bill------------------

Health and Physical Education, and Facilitation of Healthy Behaviors

All local educational agencies in a State must have a required, age-appropriate health education curriculum, and physical education curriculum, for all students in elementary schools, middle schools, and secondary schools, that adheres to national guidelines adopted by the Centers for Disease Control and Prevention (CDC) and State standards. This curriculum must provide the full amount of moderate to vigorous aerobic physical activity time recommended by the most current CDC guidelines--at present, sixty (60) minutes per day for children and teens. This can be achieved through a combination of recess, gym class, or participation in an after-school sport. In addition, all children must have access to healthy breakfast, lunch and snack options, where all foods- including competitive foods-- must adhere to Federal and State school nutrition standards. As part of this program, all children and teens must have a fair, equal, and significant opportunity to obtain a high-quality health education and physical education.

In creating such programs, each State must take the following factors into consideration:

(1) Academic and physical assessments, accountability systems, teacher preparation and training, curriculum, and instructional materials must be aligned with Federal and State standards so that students, teachers, parents, and administrators can measure progress against common expectations for student academic and physical achievement;

(2) Programs must meet the educational and physical needs of low-achieving or currently unfit children, particularly in our Nation's highest-poverty schools, obese and overweight children, limited English proficient children, migratory children, children with disabilities, Indian children, neglected or delinquent children, and young children in need of reading assistance;

(3) Programs must close the healthy behaviors knowledge gap between high- and low-performing children, especially the achievement gaps between minority and non-minority students, and between disadvantaged children and their more advantaged peers;

(4) Schools, local educational agencies, and States must provide, at a minimum, weekly education about healthy behaviors and the human body and daily access to and facilitation of healthy nutrition—including water, breakfast, lunch and snacks. Programs must promote schoolwide wellness reform and ensure the access of children to effective, scientifically based instructional strategies and access to and facilitation of healthy nutrition and physical activity according to comprehensive school wellness guidelines;

(5) Professional development opportunities must be made available to staff to elevate the quality of instruction and their own wellness training and opportunities for daily healthy nutrition and physical activity;

(6) All services under this title must be coordinated with each other, with other educational services, and, to the extent feasible, with other agencies providing services to youth, children, and families; and

(7) Programs must involve and train parents in encouraging and supporting a healthy and active lifestyle, including increased physical activity during and outside the school day, and nutritional eating habits in the home and at school.
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In broader terms, additional measures that are pivotal to prevention and wellness reform:

•Tax on high-sugar/ non-nutritional drinks and snack foods. We recommend this also be applied to diet drinks given the latest data suggesting children that consume a high amount of these drinks have similar prevalence of obesity as those that drink sugar-added beverages
•Funding allocation for PE and Health Education teachers, and Health Education curriculum materials
•Increased funding for the Carol M. White PEP grant program to support supplies (activity equipment) and program innovations (SPARK, CATCH, Polar, Hop Sports, Sports 4 Kids, etc.) for Physical Education, Recess and Sports Teams
•Funding for piloting comprehensive in-school health clinics under Medicaid/ S-CHIP
•Improvements in the foods supplied under the free and reduced lunch program and/ or funding to support cooking training and alternative food suppliers, such as Revolution Foods
•A national health behaviors social marketing and incentive program led by CDC and an alliance of social enterprises (information on our Drive 2 Fitness program model is attached, We Can!, and the President's Fitness Challenge are other models)
•Funding allocation for sidewalk, park and playground development (DoT/ States)
•Decrease/ eliminate subsidies for corn used for high fructose corn syrup
•Funding allocation to help schools implement comprehensive school health (Cambridge Health Alliance/ Shape up Somerville/ Alliance for a Healthier Generation/ Fitness Forward School Playbook/ etc.)

Please make you're voice heard now. This will likely be the largest opportunity to revise the nation's approach to health care within the decade.