Health Is Not Just About Health Care

The Robert Wood Johnson Foundation Commission to Build a Healthier America, of which I have served as staff director, recently released its report with 10 recommendations that we believe will allow Americans – particularly those who face the greatest barriers to good health – to lead healthy lives. The recommendations are rooted in a twin philosophy: Building a healthier America requires individuals to make healthy choices for themselves and their families and a societal commitment to remove the obstacles preventing too many Americans from making healthy choices.

So often, our nation’s health care debate seems to focus on providing health insurance coverage to those who currently have none. Without a doubt, this is a very pressing need, as those without health insurance often do not have access to adequate preventative care. Worse still, when the uninsured do need health care, they often face crushing personal costs or simply cannot pay at all, resulting in significant harm to themselves or cost shifts to others.

As important as health insurance coverage is, however, it is only one piece of the health care challenge. I believe that giving health insurance to every person in the United States would actually contribute only a little to improving most people’s health. Health insurance helps us get medical care when we’re sick. But medical care accounts for only about 10–20 percent of preventable deaths. If we want to live longer, healthier lives, we need to focus on factors that keep us from getting sick in the first place.

Good health is not just about having good doctors and good hospitals. It’s about having a good education and good child care when you’re very young. It’s about living in safe, clean neighborhoods where your kids can play outside and where you can buy groceries for your family. It’s having a decent home to live in and being able to raise your kids to be healthy and happy.

When you come right down to it, health is mostly about where we live, learn, work, and play. These are the places that shape our everyday health, and they are tied to powerful social factors like income and education.

These social factors can work for us or against us. For example, if you live in a safe, clean neighborhood with parks and sidewalks and supermarkets that sell plenty of fresh produce, it’s easier to be healthy than if you live in an area where there is a lot of crime; where there are no parks or sidewalks; and where, instead of grocery stores, you have little more than fast-food restaurants and liquor stores.

Let’s face it: It’s hard to eat right if there’s no grocery store nearby. You’re not going for a jog after work if you’re afraid for your safety or do not understand the importance of fitness and exercise. And it’s difficult to manage your child’s asthma if you live in a building that’s infested with roaches.

The current health reform debate in Washington has not focused on these factors, but the Commission to Build a Healthier America has. The Commission’s  recommendations provide us with a blueprint for how this nation can improve health. Unlike the frequent debates about health care coverage or costs, our report focuses on the solutions available in our schools, our homes, our neighborhoods, and our workplaces. We hope the policy making community in Washington will make use of this blueprint.

Where people live, learn, work, and play affects how long and how well they live to a greater extent than most of us realize. For the first time in our history, the United States is raising a generation of children who may live sicker and shorter lives than their parents. Reversing this trend will depend on healthy decisions by each of us, but not everyone in America has the same opportunities to make healthy choices. In many instances, barriers to good health decisions are too high for an individual to overcome. The Commission focused on the places where we spend the bulk of our time – homes and communities, schools and workplaces – in order to identify where people should make healthier choices and where society should remove the obstacles preventing too many American’s from making healthy decisions.

Health is not just health care. We need to broaden our view of health and factor health into all aspects of everyday life and decision making – from education and child care to community planning to business practices. We’ve done it with the environment by “going green” – why can’t we do it with health? An increasingly unhealthy nation is counting on us to do so.

To learn more about the work and recommendations of the Robert Wood Johnson Commission to Build a Healthier America, please visit


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4 Responses to Health Is Not Just About Health Care

  1. Ed Kobrinski

    Thank you, Dr. Williams, for your work on this project and sharing your insights about the real breadth and meaning of a healthier life. On a more global level, how similar or different is the concept of healthier living you describe to that of the assessment of “Human Development” that the World Health Organization defines or “Well Being Indexes” that is being monitored and published daily in the U.S. by Gallup-Healthways?

  2. David:

    Congratulations! Your commentary hits the nail precisely! Health reform needs to be about health and its determinants, as you so aptly state.

    Important additional material is available on this issue from the HHS Secretary’s Advisory Committee on Healthy People 2020, and also in commentaries I have done for Behavioral Healthcare.


    Ron Manderscheid, PhD
    Director, Mental Health and Substance Use Programs
    SRA International
    Rockville, MD 20852

  3. Rick Brush

    While improving “health care” quality and access is essential, our nation will not improve health and reduce costs in a meaningful and sustainable way without considering what is making so many of us sick in the first place. We need greater collective awareness — and participation — to make a difference.

    This is the work of Communities of Health ( in a growing number of communities around the country. The approach convenes all stakeholders — citizens, business, government, education, health and other sectors — in a collaborative dialogue to uncover and address social and environmental factors that are the primary determinants of health in the places we live and work.

    We applaud the Commission for its work, and call on all leaders to improve community conditions that determine health.

    Rick Brush, Co-Founder

  4. What you write plus the great observations already made before I get around to reading not to mention commenting, result in me feeling like I need to say something profound.

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Altarum Institute Distinguished Scholar