High Court’s Decision – Focus on Prevention and the Elimination of Disparities




Today’s decision by the US Supreme Court to uphold the Affordable Care Act (ACA) affirms what most health professionals know: good public policymaking helps all Americans be as healthy they can be. Moreover, the Supreme Court, through its ruling, has preserved a set of critical reforms that rebalance our health system away from expensive, avoidable treatments and toward keeping people healthy.

The Act’s insurance provisions creating coverage for 30 million Americans has appropriately received the lion’s share of attention — lack of insurance coverage is a painful burden on millions of American families. But that’s just the beginning. ACA is remarkable for giving long-delayed attention to the ways our system can actually make Americans healthier. Title IV of the Act, Prevention of Chronic Disease and Improving Public Health, and numerous other provisions direct the federal government to fund and give other infrastructure support to disease-prevention and public health initiatives. These innovative provisions can potentially reverse the alarming national trend in preventable chronic disease. The fact that 75% of our nation’s health care expenses are spent on preventable diseases like diabetes, obesity, cancer, and heart disease, should be reason enough to support this critical aspect of the bill.

Our nation’s need for the reforms in the ACA could not have been more obvious. In 2010, health care expenses in the US exceeded $2.6 trillion. According to the World Health Organization, these expenditures, both per capita and as a percentage of the Gross Domestic Product (17%), exceed those of any other nation. This spending has created the world’s most technologically sophisticated personal health care system and its richest biomedical enterprise — but the U.S. population lags significantly behind other developed countries on multiple health indicators (for example, ranking 43rd in infant mortality and 34th in life expectancy). Correcting this fundamental imbalance in the investment of our health dollars is one of the key contributions of the ACA.

Along with falling short in comparison to other systems, our system also fails to adequately support all Americans. There are significant disparities in health outcomes across geographic areas of the United States, and among certain racial and ethnic minorities, with a disproportionate burden of disease falling on poor communities. These disparities have little to no biological or genetic basis. The ACA supports population health improvement through a variety of approaches, including new models of care, investments in the public health workforce, and investment in community-based prevention.

One of the most significant contributions of the ACA is the new Prevention and Public Health Fund, with an annual appropriation that began at $500 million in fiscal year 2010 and increases to $2 billion in fiscal year 2015 and beyond (§4002). The Fund awarded $500 million in FY10 and $750 million in FY11 to states and communities to boost prevention and public health efforts, improve health, and enhance health care quality. This visionary investment allows communities to increase access to healthy foods, create opportunities for physical activity, and eliminate tobacco risks. Such changes are the best shot we have at making the healthy choice to easy choice in our everyday lives.

Today’s decision by the Court to let the ACA stand is a victory for the health of the American people and will permit continuing progress on the transformation in health policy that we need to emphasize prevention and improve the health of the American people and address health disparities.

Dr. Boufford serves as president of The New York Academy of Medicine (NYAM). An independent organization since 1847, NYAM addresses the health challenges facing the world’s urban populations through interdisciplinary approaches to policy leadership, innovative research, evaluation, education, and community engagement. Drawing on the expertise of diverse partners worldwide and more than 2,000 elected Fellows from across the professions, our current priorities are to create environments in cities that support healthy aging; to strengthen systems that prevent disease and promote the public’s health; and to eliminate health disparities.

Image via Brandon Bourdages / Shutterstock.

Jo Ivey Boufford, MD

Jo Ivey Boufford, MD, serves as President of The New York Academy of Medicine. She is one of the nation's foremost experts in the field of urban health. She previously served as Principal Deputy Assistant Secretary for Health in the US Department of Health and Human Services (HHS) and on the Executive Board of the World Health Organization. She holds a BA in psychology and MD from the University of Michigan and is board certified in pediatrics.
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