1. Ronald, Jocelyn BS
  2. Chuk, Michelle MPH


The National Association of County and City Health Officials (NACCHO) is the national organization representing local health departments. NACCHO supports efforts that protect and improve the health of all people and all communities by promoting national policy, developing resources and programs, seeking health equity, and supporting effective local public health practice and systems.


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The housing market has stalled, a recession is impending, and the debate over healthcare costs is raging. Simultaneously, the health of individuals living in the United States is far inferior to that of people in other nations, and a health system once viewed as a cornucopia of resources, miracle procedures, and high-quality care is being overwhelmed by the focus on treatment instead of prevention. The US health system produces incentives for ill Americans by paying money to those who are actively treating the sick-doctors, institutions, insurance companies, and other practitioners-and yet this country has not effectively addressed the burden this creates on our economic means.


Public health reminds us of the old adage "An ounce of prevention creates a pound of cure." If we were actually able to apply that adage to the health system in the United States, we could save millions of dollars. Each year that the United States uses the current health system, more than 1 trillion dollars are lost from lack of work productivity due to chronic illness.1 Furthermore, the United States spends 2 trillion dollars annually (16% of our gross national product) and two and a half times as much per person compared to other industrialized countries on healthcare, yet we are still not within the top 10 healthiest nations.2 More sobering is the realization that, on the list of the healthiest nations in the world, the United States ranks nearly 40 places below the top.


It is no wonder, then, that 26 percent of US adults with medical bills were unable to pay for basic necessities in 2005.3 We are watching the large cost of the US health system passing to consumers' pocketbooks and millions losing their insurance coverage. In 2007, 47 million Americans were uninsured.4 Without insurance coverage, millions of Americans are not able to interact with the heath system at all unless they experience an emergency. Individuals are not learning about prevention and wellness opportunities, nor are they receiving guidance on treating chronic diseases, which cause 70 percent of deaths in the United States each year.5


In 2008, the Robert Wood Johnson Foundation noted that children living in poverty are seven times more likely to have poor health than those with higher incomes. A large gap exists in this nation between the wealthy and the poor-the top one percent of American families owns as much wealth as the bottom 90 percent.6,7 Changing the conversation to valuing health and, thus, shifting the balance of incentives to treatment over prevention is one of the only options to making a true impact on the health of the US population before it is too late.


The Healthiest Nation Alliance is a group of local, state, and national entities who have joined forces to build the truly integrated 21st-century health system required for the United States to become the healthiest nation in a healthier world. We need to fix the health system, and the Healthiest Nation Alliance was first formed with that aspiration in mind. Members of the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, and the Centers for Disease Control and Prevention formed a steering committee for the project and have spent the last 8 months working to understand the players in the health debate; developing key messages for governmental public health, leaders in various sectors, and the general public so that everyone can be involved; and capturing the perspectives of various players related to comprehensive health system transformation.


The vision of the Healthiest Nation Alliance is to create an integrated national system in which the participants value health and work together to achieve optimal health for all. Such a comprehensive system would prioritize prevention, protect people and communities from emerging threats, and provide healthcare for every member of the public. The Healthiest Nation Alliance's goals for a reformed health system are the following:


* value and equity;


* accountability and continuous improvement;


* alignment and collaboration; and


* fundamental long-term change.



The Healthiest Nation Alliance has four distinct identifiers that separate it from the other ongoing national initiatives. First, the Alliance has an integrated approach by organizations and individuals known for their ability to convene multiple interests effectively; second, the Alliance takes a proactive attitude to health; third, the Alliance is collaborative and multisector; and finally, the Alliance focuses on making connections, not reinvention.


Although the Healthiest Nation Alliance is in its infancy, it has outlined its short- and long-term activities. The short-term activities are separated into three core categories: Defining Terms, Outcomes, and Measures; Creating Messages and Building Partnerships; and Reframing the Health Debate. In keeping with the short-term goal of Creating Messages and Building Partnerships, the Alliance is actively reaching out to businesses, medical care organizations, advocacy organizations, and the nonprofit community to broaden the Alliance's capacity to bring about the needed change in the US health system.


By connecting such organizations, the Alliance can help facilitate improved health for Americans in the following ways:


* building the case for action;


* providing the research and policy resources and information required to reinforce both the case for action and the recommendations for change;


* framing the debate around health (as opposed to healthcare) by providing a compelling, consistent set of messages that the audience can customize;


* facilitating integration among various sectors by establishing connections, building community, and engaging consumers; and


* developing and disseminating training at the community level.



For additional information about the Healthiest Nation Alliance, or if you are interested in joining the Alliance, please contact Michelle Chuk at [email protected] or (202)783-5550, Ext 209.




1. Milken Institute. An unhealthy America: The economic burden of chronic disease, charting a new course to save lives and increase productivity and economic growth. From the Milken Institute Web site: Accessed March 25, 2008. [Context Link]


2. Centers for Medicare & Medicaid Services. CMS reports U.S. health care spending growth accelerated only slightly in 2006. Press Release, January 8, 2008. From the Centers for Medicare & Medicaid Web site: Accessed April 4, 2008. [Context Link]


3. Collins SR, Davis K, Doty MM, Kriss JL, Holmgren AL. Gaps in health insurance: An all-American problem. From the Commonwealth Fund Web site: Published 2006. Accessed April 7, 2008. [Context Link]


4. US Census Bureau. Income, poverty, and health insurance coverage in the United States: 2006. From the Census Web site: Published 2006. Accessed April 7, 2008. [Context Link]


5. Centers for Disease Control and Prevention. Chronic disease overview page. From the Centers for Disease Control and Prevention Web site: Accessed March 20, 2008. [Context Link]


6. The Robert Wood Johnson Foundation Commission to Build a Healthier America. Overcoming obstacles to health. From the Commission on Health Web site: Published 2008. Accessed April 4, 2008 [Context Link]


7. Kinneckell A, Federal Reserve Board of Governors. Currents and undercurrents: changes in the distribution of wealth, 1989-2004. From the Federal Reserve Web site: Published 2006. Accessed April 4, 2008. [Context Link]