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So here we are in January 2010, conscious of the fact that our middle-aged little planet has managed to complete one more twirl around its rather ordinary star. The New Year not only gives us a chance to break out the sequined tube top (with matching thong!) and chug Champagne, but also an occasion to acknowledge the passage of time and the historical significance of the reality we’ve collectively created over the past year. For many, reflecting on the nature of time and change generates enough anxiety to fuel at least one or two New Year’s resolutions.

Even if you don’t participate in the existential crisis of making New Year’s resolutions, chances are you still have goals. Perhaps you’re like me and your goal is to stop Facebook stalking Dr. Muscles. But if you’re anything like the average non-psycho American, you’ve resolved to lose weight or quit smoking or tackle some other health-related nuisance that you’ve been meaning to address. If so, you are certainly in good company.

In fact, and this may make you more or less enthusiastic about your personal improvement vows—the federal government supports you! The feds, along with more than 400 other participating organizations, have generated a comprehensive framework for national health goals called Healthy People 2020. HP2020 is essentially a list of national health-related New Year’s resolutions for the next decade.

HP2020’s predecessor, Healthy People 2010, aimed to increase quality and years of healthy life as well as eliminate health disparities. Leading health indicators for the nation included mental health (i.e. reduce number of crazies), physical activity (i.e. reduce number of lazies) and responsible sexual behavior (i.e. reduce number of unintended babies). While HP2020 has retained many of the 2010 objectives, the program’s architects have expanded upon the original vision to include several new overarching goals for HP2020. One of the new goals is “to create physical and social environments that promote health for all.”

No one would argue that individual lifestyle choices like diet and exercise are not crucial for wellness. Yet the new goal of creating healthy physical and social environments reflects more current understandings in the health sciences that broader determinants of health—such as socioeconomic status and access to civil rights—play an even larger role in shaping health
. The idea that a person’s environment influences her health is nothing new. Turn-of-the-century public health nursing pioneers such as Lillian Wald deserve a major shout-out for addressing health needs through social activism. But historically, the profit-driven, sausage-centric medical world hasn’t exactly embraced nursing’s social consciousness. More recently, however, modern research has validated the links between life conditions (like political freedom, education, resource distribution, and social equality) and health.

According to the World Bank, America outspends every other country on health care. Yet the World Health Organization reports that life expectancy is lower and infant mortality is higher here in the U.S. as compared to other industrialized nations. It’s possible that socioeconomic, cultural, and environmental factors have something to do with why we in the United States have so little to show for our health care dollars. Perhaps certain aspects of the social landscape are incongruent with human health and wellbeing. For instance, illiteracy and poverty are known to be the some of the strongest risk factors for poor health and are more prevalent here in the U.S. than in peer countries like Canada, Germany or Japan.

Although appreciation for the health impacts of social and physical environments is rising, institutions and governments face enormous difficulty addressing these issues at the policy level. This is perhaps because the needed changes are numerous and complex. It’s not like you can just legislate a cultural shift or wake up one day and add “fix poverty” beneath “pick up milk” on your to-do list. Just as there’s a big difference between me repeatedly poking Dr. Muscles on Facebook and actually convincing him to treat me to a little professional courtesy in exam room 3, there’s a big leap between claiming you want everyone to be healthy and actually addressing the nuts (ahem) and bolts of how cultural and social practices keep people poor or uneducated or oppressed.

The health reform legislation currently being hashed out by Congress attempts to close certain gaps in health care by expanding social programs like Medicaid and offering insurance subsidies. Individual responsibility is also addressed via a new legal requirement that everyone purchase health insurance. These policies help minimize certain inequities concerning access to care, but relying solely on the health care system or the efforts of individuals to solve our health crisis just won’t cut it. As the HP2020 advisory committee states, “Responsibilities for promoting healthful environments at multiple levels—including the individual, social, physical and policy environments—go beyond the traditional health care and public health sectors.” This means that the health of our nation is truly a shared responsibility.

Although your personal resolution this January may revolve around a StairMaster and a stack of
Fitness magazines, our real challenge in the coming years will involve restructuring our society to address the broader determinants of health like equality and environmental cleanliness. Whether we do this by guaranteeing access to education, transitioning to green technologies, emphasizing the importance of social cohesion or generating policies that support local economies remains to be determined. The HP2020 advisory committee offers some generic guidance for policy makers, such as tax breaks for the working class or better education. But in reality, there’s no silver bullet and the changes needed to create healthy cells in the bodies and brains of American people will require a multifaceted, interdisciplinary approach.

So here’s to hoping that 2010 ushers in the era of collective resolve to pull our heads out of our big (and growing) American butts and make Healthy People 2020 a reality.
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