1. Carroll, V. Susan Editor

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Although the United States ranks as the third wealthiest country in the world, we rank 27th out of 34 industrialized countries in life expectancy. We are also less healthy when low birth rate and prematurity as well as disability rates and mortality rates for several major categories of disease are considered, despite spending more than any other country, $8,000 per individual, on health care. Money has not delivered better health. Differences in health and outcomes have long been apparent when we consider race, ethnicity, and income. However, it is increasingly apparent that health also depends on zip code (where one lives), education (beginning early in life), good nutrition, safe housing in safe neighborhoods, and quality child care.

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To address health inequality in this country, the Robert Wood Johnson Foundation Commission to Build a Healthier America (the Commission) has released a report "Overcoming Obstacles to Health in 2013 and Beyond." Money spent to manage symptoms doesn't address underlying diseases and the loss of life and suffering that result from them and adds to the cost burden for U.S. businesses, government, and families. That said, the Commission's work and recommendations focus not on the health care system directly but on strategies to keep people healthier. Three key priorities emerge from the report: (1) Expand access to high-quality early childhood development services; (2) revitalize low-income neighborhoods; and (3) broaden the mission of doctors, nurses, and other healthcare providers to step outside our traditional practice parameters and help address the nonmedical factors that affect health.


What do the Commission's recommendations mean for us as consumers, patients, and healthcare providers? We can expand our definition of "vital signs." Clinical vital signs typically include heart rate, blood pressure, temperature, respiratory rate, weight, and height; we can now add the nonmedical vital signs such as employment, education, health literacy, safe housing, transportation, access to healthy food, and exposure to discrimination or violence. Expanding our assessment parameters could help us make better-informed decisions about care and treatment and the additional resources patients may need. For example, in Cook County, Illinois (where I live), the life-expectancy of an individual can vary by as much as 20 years in neighborhoods that lie within a few blocks of one another. In Illinois, nearly 20% of children live in poverty, in neighborhoods identified as "food deserts" and in areas that lack easy access to primary, preventive healthcare.


The Commission reviewed a variety of models and initiatives that focus on connecting patients with nonmedical services that could help improve their health. In Denver and San Antonio, tax revenues are targeted to fund early childhood education; in Atlanta, Purpose Built Communities combines mixed-income housing, educational programs beginning at birth, and community services in ways that boost the local economy, improved educational and employment opportunities, and reduced crime. On a national level, Health Leads, a healthcare organization that operates across 6 geographic areas and serves patients from cradle to grave, helps physicians, nurses, and other healthcare providers screen patients for food, rent, and other resources deemed fundamental for better health and to "prescribe" these resources. Patients take the prescriptions to a central desk in each Health Leads clinic, where college student advocates work with patients to access existing resources. The Centers for Medicare & Medicaid Services (CMS) has implemented a program to connect patients who are frequently readmitted to acute care hospitals to social service providers, nursing homes, home health agencies, pharmacies, and other types of health and social service agencies in local communities. The Centers for Medicare & Medicaid Services' Community-Based Care Transitions Program is currently working with 102 different organizations and had made up to $500 million in funding available through 2015 to acute care hospitals willing to partner with community-based organizations.


How can we, as neuroscience nurses, move these recommendations forward? We can begin to look at our patients a bit differently. Patients with acute and chronic neurologic disorders often have enormous needs, and, for those who come to us without the fundamentals needed for general good health, pose even greater care challenges. We can donate time and talent to organizations in our own local communities. We can become more politically active, either as individuals or through our professional organizations. We can participate fully in our employer's community health needs assessment; as a part of the Affordable Care Act, every nonprofit hospital in the United States is required to conduct a community health needs assessment every 3 years. Once completed, the hospitals must then implement a plan to address the identified needs. Finally, think about healthcare differently. Health is not solely a product of healthcare but is in fact far more.


* To learn more about the Commission and its report, go to


* To learn more about health disparities and inequalities, see the Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (MMWR), 2013, Vol. 62, Supplement, No. 3 (http://



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