evaluation of the commission to build a healthier america
DESCRIPTION
The Commission to Build a Healthier America was created in February 2008. The effort was led by former Congressional Budget and Office of Management Director, Alice M. Rivlin, and former Centers for Medicaid and Medicare Service administrator, Mark McClellan. Its final report, entitled Beyond Health Care: New Directions to a Healthier America, was an effort “to go beyond traditional definitions of health to identify promising and important policies that can help each person and each family live a healthier life.” Although its final report addressed ten specific recommendations, the real power of the commission lay in its focus on setting the future health agenda. By taking a “broader look at how health is shaped by how and where we live our lives,” the commission worked to reframe the prevailing health dialogue to encompass broader social determinants, such as those embedded in education and income. In focusing on the need for hard facts and clear evidence of effectiveness, the commission moved steadily toward a new way to think, talk, and act to improve health. This presentation is based on a careful reading of the commission’s work, internal documents and reports, thirty not-for-attribution interviews with commissioners, staffers, grantees, health advocates, senior policymakers, and funders, and comparisons with the most significant blue ribbon government commissions since 1945. We began our work on September 1, 2012, and completed this final assessment on April 1, 2013. The research was designed to provide the Robert Wood Johnson Foundation (RWJF) with tangible suggestions for enhancing the commission’s future influence.TRANSCRIPT
04/13/2023 1
Commission to Build a Healthier America:
A Fourth Year Review
April 2013
Paul LightNerissa Clarke
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“If you really want to move the needle on life expectancy, quality of life, the kinds of things that the commission focused on, it’s not
going to happen through traditional healthcare reform alone. It’s only going to happen through the kind of changes in behavior supported
by the changes in policies, and other steps to change the environment that the commission talks about in its report. Obviously
we haven’t succeeded in doing all of that yet.”
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Project Questions
I. History: Why was the commission created and how was it structured? II. Theory of Change: What was the commission’s framework and theory of change?
III. Footprint and Impact: How did the commission create its mark on history?
IV. Opportunity: Where is there room for impact in the future?
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- Literature review- Document review- Internet searches
- Citations- Media coverage- Congressional publications- Public Health curricula
- 30 interviews- Data analysis
Methodology
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• Raise awareness among policy-makers and the public about the substantial shortfalls in health experienced by many Americans
• Identify interventions beyond clinical services that demonstrate promise for improving overall health and reducing disparities
• Recommend to the Foundation and the nation’s leaders key actions outside medical care that communities, businesses, unions, philanthropies, faith-based organizations, civic groups, local governments, the states and the federal government can take to create greater opportunities for long and healthy lives for all Americans
The Charge
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I. Theory of Change
Inputs
• Existing Research• Staff Expertise• Commissioners• Public Health
Demonstrations• RWJF funding• Stakeholder
receptivity
Activities
• Hearings • Site Visits• Research/
Publications• Outreach• Media Production• Events• Interactive Tool
Development
Outputs
• Think• Agenda setting• Reframing
definition
• Talk• Enhance national
visibility• Foster cross-
sector dialogue
• Act• Leverage limited
resources• Optimize impact
Outcome
• A healthier nation for all Americans
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The Commission’s work promoted a healthier America for all Americans by changing the way we think, talk, and act
THINK:“We need to take a look beyond medical care to other factors that can improve America’s health”
TALK: “We hope to spark a national conversation [across sectors] about committing to health and wellness for everyone”
ACT: We must “focus on those [interventions] with the strongest potential to leverage limited resources and optimize the impact of federal investments”
Framework
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Think
• Expand traditional definitions of health
• Support evidence-based research
• Invest in tough measurement techniques
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Talk
• Foster collaboration• Develop common language around social
determinants– “Health is more than healthcare”– “Health starts where you live, learn, work, and
play”
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Act
Leverage scarce resources:
• Target vulnerable populations (children)
• Replicate success (innovation, partnerships)
• Measure, measure, measure
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II. Footprint & Impact
Footprint is a measure of the “good commission”• Focus on process of “doing it right” • Work horses, not show horses • Some lightweights have high impact; some
heavyweights have little or none
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“I do feel that the commission helped. Obviously the momentum was there, the ideas were there,
and the receptivity to this kind of stuff was there. But my feeling is that the commission just
helped… all of it helped to drive it forward. Of course at the end it’s hard to pin down exactly
what one thing was the most influential.”
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Scoring FootprintsEleven Weights:
1. Length
2. Breadth
3. Complexity
4. Leadership
5. Freedom to Investigate
6. Visibility
7. Seriousness
8. Thoroughness
9. Leverage
10. Durability
11. Bipartisanship
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Comparing Footprints
Commission received 8 out of possible 11 with zeroes for:
• Visibility (can’t be
recovered)• Leverage to policy
(can be debated)• Durability (can be
enhanced)
Footprint
Name Launch Date
11 9/11 Attack 200211 Social Security Financing Crisis 198110 Base Closing and Realignment 198810 Government Reorganization 194710 Preventing Terrorist Attacks 199810 Quality of Care for Wounded Warriors 200710 Space Shuttle Challenger Accident 19869 Conduct of Iraq War 20039 Defense Department Fraud, Waste, and Abuse 19859 Deficit Reduction 20109 Urban Riots 19678+ HEALTHIER AMERICA 20088 Internal Revenue Service Abuse 19968 John F. Kennedy Assassination 19638 U.S. Intelligence Agencies 19947 Airport Safety 19527 Aviation Security and Safety 19967 Crime in America 19657 Executive Branch Reorganization 19697 Stimulus Oversight 20096 Educational Quality 19816 Strategic Missile Basing 19835 Government Response to the HIV/AIDS Epidemic 19875 Gulf War Syndrome 19954 Central America Policy 19834 Three Mile Island Nuclear Accident 19793 Space Shuttle Columbia Accident 20032 Kent State Campus Unrest 19701 Central Intelligence Agency Financing of Private
Organizations1967
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III. Impact
Impact is a measure of ultimate success—doing it right is not enough
Two measures of impact:
1. Head-to-Head with other blue ribbons
2. Sum of the parts on its own
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1. Head to Head Impact Name Launch
Date4 9/11 Attack 20024 Base Closing and Realignment 19884 Crime in America 19654 Defense Department Fraud, Waste, and Abuse 19854 Government Reorganization 19474 Preventing Terrorist Attacks 19984 Social Security Financing Crisis 19813 Airport Safety 19523 Conduct of Iraq War 20033 Educational Quality 19813 Executive Branch Reorganization 19693 John F. Kennedy Assassination 19633 Quality of Care for Wounded Warriors 20073 Space Shuttle Challenger Accident 19863 Stimulus Oversight 20093 Strategic Missile Basing 19832 Aviation Security and Safety 19962 Central America Policy 19832 Deficit Reduction 20102* HEALTHIER AMERICA 20082 Internal Revenue Service Abuse 19962 U.S. Intelligence Agencies 19942 Urban Riots 19671 Central Intelligence Agency Financing of Private
Organizations1967
1 Government Response to the HIV/AIDS Epidemic 19871 Gulf War Syndrome 19951 Kent State Campus Unrest 19701 Space Shuttle Columbia Accident 20031 Three Mile Island Nuclear Accident 1979
Four-point measure: 1. Little or none2. Moderate3. Large amount4. Great deal
Commission received a 2-point score (for now)
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2. Sum of the Parts
1. Commissioners2. RWJF3. Community
Development4. Health Field5. Policy Agenda
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Impact on the Commissioners
• On knowledge• On application• On future
engagement• On health not being
healthcare
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“The Commission’s lesson was not a funding strategy for RWJF, it was a
framework. One of the biggest things that came from it was that it altered the way
RWJF's top leadership was thinking about social determinants of health.”
Impact on Robert Wood Johnson Foundation
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Impact on Community Development
“Seeing the foundation take something and move it and spread it into places where we probably couldn't have gone; to see the
Federal Reserve Bank so owning expanded notions of health and
vitality. That’s huge.”
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“From where I sit, I watched the conversation about health really be focused on healthcare across the
health policy world, which is really our world, and to see now that so many organizations are really beginning to
shift their focus toward the social factors that impact health. I think the
commission started a new dialogue on health. I think they were really
effective at doing that.”
Impact on Health Field
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• Healthy Food Financing Initiative• Affordable Care Act• Healthy Hunger-Free Kids Act
Impact on Policy
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IV. Opportunities
Goal:
1. Raise durability– Of commission– Of framework
2. Support advancement in the field
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Specific Strategies
1. Create a sense of urgency2. Build an implementation plan3. Deeper Environmental Scan: Partnerships4. Press the case for policy change
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1. Create Urgency
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2. Build Implementation Plan
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3. Scan the environment
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4. Press the case for policy change
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Conclusion
Where Next?