In terms of public health, the 2016 presidential campaign has been limited to debate around the Affordable Care Act -- its benefits, its shortcomings and its future. But the next Administration will face a much greater challenge: Ensuring that Americans live longer lives in good health. If they don't, the cost to the nation will be astronomical, given heavy reliance on Medicare for older Americans and the sad fact that Americans younger than 50 are sicker than people in other wealthy nations.
In the last century, our life expectancy has grown by 30 years. That extraordinary achievement has added a new third stage of life after childhood and middle age but before the last years. That new stage can hold dramatic benefits for individuals, families, communities, and the nation as long as we reach it, and remain there, in good health.
It is time for a presidential platform that supports disease prevention and healthy living. The science of prevention has a very high return on investment so these five objectives should appeal to candidates of any political persuasion.
(1) Make Healthy Food, Like Clean Water, a Staple
The U.S. Department of Agriculture estimates that 23.5 million Americans live in food deserts, lacking access to fresh and affordable food. More than half of them, 13.5 million, are low-income. While healthy food is primarily provided through private enterprise, the government has regulated other industries -- notably aviation and banking -- to ensure that the entire country is effectively served. Fourteen percent of U.S. households, home to more than 16 million children, experience some form of food insecurity. Why is food of less concern? Why are food deserts allowed to persist? Why are so many hungry? The federal government must work with local governments and businesses to ensure that healthful, balanced nutrition is within reach geographically and financially.
(2) Design Health Systems for Longer Lives
By 2030, more than 20 percent of the nation's population will be over age 65. It's time to invest in expert professionals who understand healthy aging, and the medical, public health, and social systems that can support it. Medicare has the opportunity to support the health of older adults in sickness and in health. With more than 80 percent of Americans living in urban areas, it is also crucial that we prepare our cities for healthy and successful aging. The Commission for New York City's Age-Friendly N.Y.C. has identified four goals which provide a model for the nation: (a) improving social inclusion, civic participation and employment opportunities for older adults; (b) increasing the availability and affordability of safe appropriate housing; (c) providing age-friendly public spaces and a safe means for reaching them; (d) ensuring access to health and social services to support independent living.
What's more, we need to give the next generation of older adults a healthier start. Almost a quarter of U.S. children grow up poor, exposed to environmental toxins, violence, and inadequate housing. Too many are overweight or obese, setting them up for a lifetime of ill health. Until we recognize that these early life exposures are obstacles to a lifetime of health, U.S. health will remain ranked behind all peer nations.
(3) Increase Federal Funding of Scientific Research for Prevention and Care
Curing disease is crucial but preventing it more cost-effective. With chronic diseases, the dominant cause of ill health in the United States, evidence-based approaches to keep us healthy must be a priority. One in 10 Americans has diabetes, for instance, a figure that could soar to one in three by 2050 if current trends continue. As many as five million suffer from Alzheimer's disease, and that number is expected to triple by 2050. Yet R&D funding to help us better prevent these conditions has declined from 9.1 percent of the federal budget in 1968 to 3.6 percent today. If we do not make a larger commitment to research now, we will pay a much higher price later.
(4) Develop New Civic Institutions to Benefit both Older and Younger Americans
The new third stage of life provides an extraordinary opportunity for older Americans to work or serve as volunteers with nonprofit organizations, civic groups, and even within the government. Research-proven examples exist of institutions that engage older Americans in volunteering improve the health of young and old alike. As Americans age, such a system could simultaneously optimize the assets of the older generation, provide social dividends for younger generations, and strengthen institutions engaged in crucial work in our cities and elsewhere. A national system of service should be designed to extend this kind of triple-win.
(5) Tackle Climate Change
The world's climate is changing, and the effects -- altered weather patterns, flooding and drought, more intense storms, and rising sea levels--have a great bearing on human health. Though conditions will vary in different parts of the country, all regions need emergency response mechanisms to deal with extreme weather events, displaced populations and the public health consequences. Research into climate change, its expected effects, and the best mechanisms to prevent and combat them should be a top priority.
The key to living longer healthier lives is prevention, which works at every age and stage of life. Half of health is created by factors that lie outside of individual control, so health across the life course depends on actions we take collectively. White House hopefuls take note: This is public health for the 21st century.