2020 was arguably one of the most difficult years in American history, challenging our resilience and facing lasting and systemic challenges to our collective health and well-being. As we continue to measure the impact of the pandemic on short-term and long-term health, as well as other social and economic indicators, it is useful to note where we stood before the pandemic. Understanding the conditions and trends that shaped our health before COVID-19 helps us to assess whether the systems being tested now are robust to responding to COVID-19.
Last year, the Robert Wood Johnson Foundation (RWJF) shared with the RAND Corporation Update on the national set of measures That we are using to track our journey towards a culture where every person has a fair and just opportunity to lead a healthy life. The goal of a culture of health interventions is to offer signs of change The role of all sectors in influencing health outcomes, with a focus on the broader social and economic drivers of health, well-being and equity. Developing a clear picture of what is (or is not) changing through a culture of health interventions is useful for guiding investment and recognizing that as a nation, we need to make progress.
What was the health of the country before the pandemic?
In 2019, when we updated the measures, we reported small, positive changes in appreciation for social determinants of health and the need for broader community health investment. However, we also saw slow progress on education, housing and other systemic factors affecting health, welfare and equality. Now, COVID-19 has increased the stress on many of those systems.
In our 2020 update, we have again made some notable improvements in areas most vulnerable to the effects of the pandemic (eg, mental health, health care). Nevertheless, progress has been slow on the social and economic drivers influencing health. Here’s what we found.
- Some progress is being made in the health sector. To achieve a culture of health, sectors outside health care and public health (eg, media, business) must recognize and take advantage of their impact on health outcomes. for example, youth exposure to advertising Parents of children are asked by the corporate food and beverage sector to buy specific—and potentially unhealthy—foods. The challenge may become even more dire as families remain at home during the pandemic. In 2018, data from Nielsen Media Research indicated that young children saw an average of 1.7 food product ads per day during children’s programming, down from 2.5 ads in 2015. About 71% of advertised products failed to meet federal guidelines for nutritional standards, down from 80% in 2015. While more improvement is needed, these pre-pandemic decreases indicate that the food and beverage sector is either creating healthier products or reducing the advertising of unhealthy products for children – which increases equity in terms of healthy weight. can improve.
- Progress on mental health and wellness is mixed. Adverse Childhood Experiences (ACE) Mental illness has been linked to chronic health conditions and premature death. The physical, social, and economic environment in which children live can affect their exposure to ACEs. There can be signs of hope on this front. National Survey of Children’s Health The data showed that, in the most recent data (2017–2018 school year), 42% of children in the United States had one or more ACEs, such as family divorce, domestic violence, or drug or alcohol use in the home. usage problem. This is a decrease of 3 percentage points from what was reported in 2016-2017. While this finding is promising, it will be important to track whether the epidemic worsens and increases in exposure to ACEs. In contrast, general well-being as measured by life satisfaction did not improve in the years before the pandemic, as did OECD Better Life Index, which found no improvement in life satisfaction among US residents aged 15 and older from 2014–2016 to 2015–2017 (reported only on a 6.9 on a ten-point scale). Now the pandemic is testing an already low American life satisfaction possibly worsening due to COVID-19.
- The health sector is improving, but costs remain high and the illusion of flexibility remains.
- The new payment and health care delivery model aims to provide high value care. Analysis by Levitt Partners found that, as of the end of 2019, about 12% of the US population had a health care provider that is part of a population-based alternative payment program, an increase of about 2% since 2018. This may mean that more people have access to a health care provider. Better care at less cost.
- However, the news before the pandemic was not entirely rosy. According to Medicare Beneficiaries Data (Kapinos, 2020), The median total health expenditure in the last year of life in 2017 was $66,176. That number has grown on average by about $3,000 a year since 2013. Health care bills pending the pandemic will only add to rising health care costs.
- Finally, delete Scope of practice barriers for nurse practitioners Can expand their ability to provide diagnostic and treatment services, which can improve the COVID response, especially in medically under-served areas. But before the pandemic, there was no increase in the number of states with full practice laws for these health care providers (holding in only 22 states since 2017).
Progress on creating healthier, more equitable communities remains slow. Community conditions that represent some of the most confounding, systemic issues are usually not tracked with other health measures, even if they have a significant impact on health. no improvement in Environment protection Such as the number of states with cross-sector climate action plans (in fact, Alaska scrapped its plan) or states with air quality protections in bars and restaurants. The 2020 count on racial issues comes at a time when there is still significant racial residential segregation in the nation. And while the percentage of American households in 2018 did not change compared to previous years spending 50% or more of your income on housing (12%), there has been some improvement in the burden on communities of color since 2014 (an average reduction of 3%). However, there remains a disproportionate burden of housing costs on Black, Hispanic/Latinx and American Indian/Alaskan Native families, communities that are disproportionately affected by COVID-19.
What do these changes mean and where do we go in view of the pandemic?
Measuring health before the pandemic and the social and economic factors that affect it gives us an idea of the risks the country faced before the 2020 catastrophe. In short, the nation was making slow progress in some areas but not moving the needle as fast as many would expect to improve key aspects of our health care system, our environment and our economic conditions. The critical systemic changes needed for more transformative health reforms have been slow or stalled and, as a result, inequalities are widespread.
As we look forward and gain more detailed information on the effects of COVID-19, it will be important to track whether these health culture measures worsen or appear resilient to further stress. Even though it is unlikely that we will see improvements in many areas of health, social status and the economy during the pandemic, by continuing to track the choices and investments made by various sectors to cultivate healthy communities, the choices we make and the can inform the guidelines. going forward. In fact, it could be critical to the country’s ability to recover from 2020.
A full description of these measures and their underlying data can be found here www.rwjf.org/cultureofhealth. Progress on these is imperative if we are to be a healthier, more equitable country.
About the Author
Carolyn E. Miller Robert Wood is a senior program officer in the Johnson Foundation’s Research-Evaluation-Learning Unit.
Anita Chandra Rand is the Vice President and Director of Social and Economic Welfare and is a senior policy researcher at the Rand Corporation.
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