Health reform wants you (to spread the word)!

National Institutes of Health (NIH) director Francis Collins recently sent a shout out for help spreading the word about the upcoming USA Science and Engineering Festival (October 23-24th in Washington DC), and his "5 critical pathways for science" that he sees as vital to advancing health sciences. These efforts are clearly aimed to latch onto the health reform band wagon, and to spread the word, Collins is hoping for a social media storm to join in his efforts.

His 5 pathways, well covered here at Justmeans, are:

1. High tech approaches to basic biology, such as nanotechnology.

2. Advancing drug design and delivery

3. Developing the science of health reform (which echoes recent advances in the nascent science of health care delivery)

4. Changing incentives for tackling global health priorities

5. Empowering innovations.

Not everyone is swayed by Collins' list. Frequent Justmeans commentator, and professor at Dartmouth Medical School Sharon McDonnell, MD, MPH, posted a thoughtful critique on her blog.

It may be semantics, but Collins could have been more accurate to refer to "health care" rather than "health". While the US and many other countries find themselves caught up in what is being called "health reform," the role of medical systems is generally being over-emphasized. Expanding health care access and quality is important, but only accounts for an estimated 10-20 percent of human health. Scotland, for example, has high quality health care that is free to all citizens at the point of care. But research by Sir Michael Marmot has found a 29-year difference in life expectancy between the wealthiest and poorest Scots. Despite equal access to care, clearly other factors are killing Scotland's poor. True health reform requires that we improve education, infrastructure, the environment, housing, economic opportunities, transportation, advertising. In short that we address the laundry list of underlying social and behavioral determinants of health that have far greater impact on health than a trip to the doctor.

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