Health Affairs, 25, no. 4 (2006): 1005-1008 doi: 10.1377/hlthaff.25.4.1005 © 2006 by Project HOPE	New Online   House Health Reform Bill   Paying for Reform   Vetting AHIP's Report   HIV/AIDS Costs   Brief: Insurance Reform   HA Blog Top 10

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Prevention

PERSPECTIVE

A Vision For A Healthier America: What The States Can Do

Abstract

 
States face a growing chronic disease burden that threatens to overwhelm their fiscal resources and health care systems. Consequences of inaction—for individuals, states, and our country—are incalculable. To maintain global economic competitiveness, reduce burgeoning health care costs, and ensure that our children have healthy futures, disease prevention/health promotion must become a core value in state government. Although personal responsibility is crucial to attaining wellness, governors can play an essential role in reorienting states’ actions toward prevention of ill health. Governors can motivate a shift in U.S. culture toward wellness through three primary avenues: communities, worksites, and schools.

I’ve often said that I’ve always eaten food deep-fried with gravy on it, just the way God intended. That lifetime of indulgence eventually took its toll. Three years ago, when miserably overweight, I went to my doctor, and the diagnosis was fairly simple: "You’re fat," he said. I was also diagnosed with type 2 diabetes. My doctor told me that if I didn’t make some serious lifestyle changes, I was probably in the last decade of my life. I consulted with a team of doctors who put me on a weight-loss program, one that involved developing healthy eating habits, balanced nutrition, and exercise. I learned that my weight problem wasn’t going to go away without a serious lifestyle change. After years of yo-yo dieting, I have now lost more than 100 pounds.

I used to be out of breath after walking up a flight of stairs. Those days are long gone. I have now run three marathons and don’t plan to hang up my running shoes anytime soon. People always ask me how I have time to exercise with my busy schedule as governor of Arkansas. I always say, "You don’t ‘find’ time to exercise; you ‘make’ time."

Although my weight-loss battle was a very personal one, my position as governor allows me to help others see the importance of making healthy lifestyle changes. Poor health habits threaten the fabric of our communities. Because of poor habits, many people are at increased risk for chronic diseases, and the state often incurs their health care costs. Businesses are similarly affected by poor health through decreased worker productivity and increased cost of health insurance. As a result, individuals, families, and communities are placed physically and fiscally at risk.

I believe that states have both the responsibility and the opportunity to address this threat. As Arkansas’ governor, I launched the Healthy Arkansas initiative in May 2004.² In February 2006, as chair of the National Governors Association (NGA), my fellow Healthy America task force members and I challenged the country’s governors to improve the health of all U.S. citizens.

In this report I provide a profile of Healthy America and a rationale for governors to pursue health promotion activities in their respective states. State leaders can incorporate these policies to make immediate changes aimed at preventing chronic disease and create a culture of wellness across the nation.

Governors’ Role In Promoting Health

Top Governors' Role In Promoting... Healthy America Goals And... Outcomes Of Governors' Actions... NOTES

 
Creating successful statewide health improvement programs requires two key elements. The first is coordination of activities across multiple state agencies to make everyone’s efforts more efficient. The second and perhaps most important element is to partner with and rely upon the advice and guidance of public health policy and research experts. In addition, governors can structure their cabinets to ensure that health is a priority across both traditional and nontraditional state agencies, as I have done by creating a new cabinet position, the Arkansas surgeon general. Using this team approach is essential to successfully combating threats to the health of our states and the country.

Governors’ positions as states’ CEOs offer them a unique opportunity to encourage and facilitate health promotion and disease prevention. We not only serve as role models, but also can use our executive powers to encourage statewide policy changes that improve health.

Legal responsibility. As sovereign entities, states have both the authority and the duty to enact laws and regulations to advance the public’s health through exercise of their police powers, or parens patriae powers, which allow states to act for those unable to adequately care for themselves—for example, children, or people with disabilities.³ In tandem, these concepts clearly support states’ engagement in actions that maintain and improve health.

CEOs. Functioning as states’ chief executive officers, governors have responsibilities analogous to corporate CEOs: to report to shareholders (citizens), to provide fiduciary oversight of capital (education, highways, health care), and to forecast (future economic and social needs). This governor-as-CEO role encompasses both the opportunity and the responsibility to shape the state’s strategic plan related to health, identify strengths of and threats to citizens’ health, seize opportunities, and minimize future risks.

Program manager. The executive branches of state (and federal) governments are uniquely able to influence program execution and management. Although legislatures initiate programs and authorize spending, governors have either direct control of, or the ability to implement and manage, most public-sector programs funded by state or federal governments (Medicare notably excepted). Incorporating health promotion strategies into traditional health-related programs (for example, Medicaid and public health) as well as nontraditional programs (for example, food stamps and economic development) provides a major opportunity to promote and improve health.

State spokesperson. Governors are often the most recognized and sought-after public spokespersons for state-level issues. Also, they frequently serve as messengers for sponsored advertising through state promotions (such as program awareness or economic development). As such, governors command a "bully pulpit" unequaled in its potential for developing and deploying messages.

Role model. Governors serve as role models within their states, often influencing participation in positive activities (for example, drug-free programs) or changes in behavior (such as anti-littering campaigns). As public figures, governors, through their lifestyles and health habits, can model behavior that influences the decisions of private citizens.

Healthy America Goals And Objectives

Top Governors' Role In Promoting... Healthy America Goals And... Outcomes Of Governors' Actions... NOTES

 
Annually, the nation’s governors select a leader to serve as the chair of the NGA and represent state interests in debate, dialogue, and negotiations. After being elected as the 2005–06 chair, I chose health as the focus of my chairman’s initiative and challenged other governors to improve the health of their citizens. Replicating and building upon Arkansas’ experience, the Healthy America Initiative was launched at the NGA winter meeting in February 2006 with support from the Healthy America task force—Governors Janet Napolitano (D-AZ), Arnold Schwarzenegger (R-CA), Tom Vilsack (D-IA), Mark Sanford (R-SC), and Phil Bredesen (D-TN).

Healthy America goals are intended to provoke immediate action by governors. The initiative proposes effective actions governors can take to improve the health of their constituents in three areas: communities, worksites, and schools. These actions are based on a governor’s ability to increase awareness of issues, achieve stakeholder engagement, and provide incentives for change toward healthier lifestyles. The actions include programs with empirical support (or those with demonstrated achievement) that can be deployed by governors without federal action and with limited or no state legislative action.⁴

Wellness where we live. Although individuals must take action to improve their own health, their social and physical environments also play a role in achieving and maintaining good health. Governors can ensure that public programs and policies are consistent with wellness goals and that messages throughout the state reinforce health goals. Governors can also (1) educate the public about existing community resources; (2) partner with community organizations to communicate information and encourage healthy lifestyles; (3) promote civic and personal responsibility for health; (4) improve access to healthy options in disadvantaged communities; and (5) publicly share their efforts to get healthy.

Agencies that report to the governor can create community changes that encourage healthy behavior, such as safe walking routes, improved nutritional guidance in public assistance programs, and setting goals for all state agencies to include health on their agendas.⁵

Wellness where we work. Rising health care costs threaten the competitiveness and, potentially, survival of U.S. businesses. When employers provide on-site wellness programs and incentives for employees to improve health behavior and manage personal health risks, a healthy and more cost-efficient workforce results. As leaders of their state’s employees (often the largest employee pool in the state), governors can implement wellness programs that include health assessments, guidance/coaching, health management plans, and behavior incentives. Changes in the largest plan in the state can influence other private-sector coverage decisions. Governors can also recognize and reward private-sector employers who commit to employee health and can form coalitions and advisory groups across the public and private sectors.⁶

Wellness where we learn. For children, much of each day is spent in schools. Working through school districts, governors can play a crucial role in student wellness and learning lifelong health habits. Governors can advocate for improved health education and regular physical activity during the school day, encourage school districts to improve the nutrition and physical activity environment of schools, engage parents through school-provided information about students’ fitness levels, convene public forums to promote physical activity and healthy foods within schools, and encourage schools to use local chefs and farmers to offer healthy foods.⁷

Outcomes Of Governors’ Actions To Improve Health

Top Governors' Role In Promoting... Healthy America Goals And... Outcomes Of Governors' Actions... NOTES

 
Governors and other state-level advocates have achieved substantive advancements in health by developing and implementing immunization programs, smoking restrictions, and seat-belt requirements. Similarly, the habits that most egregiously rob families and communities of their health—tobacco use, physical inactivity, and poor nutrition—can be addressed through state leadership. States’ governors have the ability to empower traditional and nontraditional groups to promote health and prevent disease. By engaging in actions such as those promoted by Healthy America, governors can build economic and business cases to support health promotion and disease prevention efforts and engage partners to achieve broad-scale health improvement, thus securing future wellness.

To maintain global competitiveness, reduce swelling health care costs, and give our children the healthy futures they deserve, governors must commit to decisive action. States cannot afford to focus efforts on improving disease treatment yet fail to invest in the maintenance of their citizens’ health. Governors and the citizens they represent must create a culture of wellness in the United States.

Editor's Notes

 
Mike Huckabee (Mike.Huckabee{at}gov.state.ar.us) (R) is governor of Arkansas.

Governor Huckabee acknowledges the substantive contributions of Joseph Thompson, Arkansas surgeon general, to this work.

NOTES

Top Governors' Role In Promoting... Healthy America Goals And... Outcomes Of Governors' Actions... NOTES

 

1. Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Survey Data, 2004, http://www.cdc.gov/brfss/index.htm (accessed 22 March 2006); and U.S. Census Bureau, American Fact Finder Fact Sheets: Arkansas and United States, 2004, http://factfinder.census.gov (accessed 23 March 2006).
2. See the Healthy Arkansas Web site at http://www.arkansas.gov/ha/home.html (accessed 3 May 2006).
3. L.O. Gostin, Public Health Law: Power, Duty, and Restraint (Berkeley: University of California Press, 2001).
4. Healthy America Taskforce, Creating Healthy States: Actions for Governors, ed. K. Nolan and J. Mulheron, February 2005, http://www.nga.org/Files/pdf/0602CREATINGHEALTHYSTATESACTIONS.pdf (accessed 28 April 2006).
5. National Governors Association, Center for Best Practices, "Creating Healthy States: Building Healthy Communities," Issue Brief, 25 February 2006, http://www.nga.org/Files/pdf/0602CREATINGHEALTHYSTATESCOMM.pdf (accessed 28 April 2006).
6. NGA Center for Best Practices, "Creating Healthy States: Building Healthy Worksites," Issue Brief, 25 February 2006, http://www.nga.org/Files/pdf/0602CREATINGHEALTHYSTATESWORK.pdf (accessed 28 April 2006).
7. NGA Center for Best Practices, "Creating Healthy States: Building Healthy Schools," Issue Brief, 25 February 2006, http://www.nga.org/Files/pdf/0602CREATINGHEALTHYSTATESSCHOOL.pdf (accessed 28 April 2006).

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