Improving Health Social Determinants and Personal Choice

Sir Michael G. Marmot, PhD, Ruth G. Bell, PhD

Although medical care is important, our reviews of research and the hearings we’ve held have led us to conclude that building a healthier America will hinge l argely on what we do beyond the health care system. It means changing policies that influence economic opportunity, early childhood development, schools, housing, the workplace, community design and nutrition, so that all Americans can live, work, play and learn in environments that protect and actively promote health.
Statement from commissioners from Commission to Build a Healthier America

This clear, crisp statement is fundamental. It has the possibility to change the way policymakers and the public think about health. Health care grabs the headlines. The noisy discussion of reform of the U.S. healthcare system—characterized less by informed debate than by misinformation (“don’t let the government meddle withmyMedicare” was particularly appealing)—should be put in this broader context. Providing health
care for people when they are sick is important. But the RobertWood Johnson Foundation (RWJF) commissioners’ statement above makes clear that it is environments in which people live, learn, work, and play that need to be changed if Americans are to enjoy good health./.../
In its report to the commission, Overcoming Obstacles to Health, which was the starting point for the commission’s deliberations, the RWJF highlighted two issues.