Opinion, Berkeley Blogs

What's the biggest driver of health care costs? Our personal behaviors.

By Steve Shortell

The recently passed Affordable Care Act extends health insurance coverage to 32 million Americans, including at least 6 million people in California alone. But expanding access to health care will do little to improve our health.

Fifty percent of the determinants of health are due to our behaviors; 20 percent to environmental factors; 20 percent to genetics; and only 10 percent to having access to medical care. Yet in California and as a nation we spend 96 percent of health expenditures on medical services and only 4 percent on preventing disease and promoting health.

The majority of the most costly health conditions are preventable, including obesity, diabetes, heart disease and asthma. Physical inactivity and obesity cost the state $388 million per year in workers' compensation and $11.2 billion in lost productivity.

Fifty-six percent of California adults and 30 percent of our children are overweight or obese. The total economic impact of asthma in the state is $14 billion, including 14 million lost school days and 14.5 million lost workdays. Even a modest 5 percent reduction in these and related illnesses could save the state up to $1.6 billion a year.

Interventions are needed that recognize the interaction between our personal behaviors – diet, exercise, lifestyle – and the communities in which we live.

Taking personal responsibility for our health is important. But we can make healthy choices only if there are healthy options to choose from. We need to ensure that the decisions we make about our community are those that promote healthy living; that make it easier for us to do things that promote our health and well-being and difficult to do things that are harmful.

This means access to clean air, safe water, fresh fruits and vegetables, environmentally safe buildings, parks, recreation, roads, and education and cultural opportunities. This is the philosophy of "health in all" policies in which the goal of reducing illness and injury is embedded in cooperative efforts that link our public health and medical institutions with our education, agriculture, housing, transportation and related sectors.

For example, if we design housing with access to trees, parks and recreational facilities, residents are more likely to engage in physical activity and less likely to suffer from heat-related illnesses in extreme weather than if we have housing designed or located without such features. Building attractive and green housing has health benefits.

The health care reform legislation offers some opportunity to enact "health in all" policies. A Prevention and Public Health fund is created along with a Federal Preventive Services Task Force and a Public Health Council. Ten billion dollars will be allocated over the next five years for prevention programs. This includes a "Creating Healthier Communities" grant program for health departments to implement various prevention initiatives to reduce chronic diseases and eliminate inequalities in health by race, ethnicity and socioeconomic status.

But California, and many other states, will be challenged to respond to this opportunity due to a severe shortage of trained public health professionals, inadequate data systems and the need for performance standards.

To seize the opportunity to invest in health and reduce the economic burden of disease on the state will require creative leadership on the part of both public officials and the private sector. Concerted efforts to provide the leadership and resources to address the underlying behavioral, social and environmental determinants of health will have a greater impact on our health status and economy than any of the health care delivery system efforts to cope with the expanded access to care afforded by the increase in health insurance coverage.

Cross-posted from The Sacramento Bee.