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Final Recommendations of the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health to the Surgeon General and the National Prevention Council Approved on June 11, 2015

At our March 9-10, 2015 meeting, the Advisory Group on Prevention, Health Promotion and Integrative and Public Health reaffirmed the value of and our commitment to the four strategic directions of the National Prevention Strategy  -- in particular those that promote equity in the United States: elimination of health disparities and empowered people.  In keeping with this equity framework, the Advisory Group makes the following recommendations based on our deliberations on March 9 and 10, 2015:

Recommendation 1: Surgeon General’s Priorities

We were delighted to meet with the new Surgeon General to review our prior recommendations for the Surgeon General’s office and to discuss his priorities during his tenure.  We applaud his commitment to make prevention and equity the bedrock of all his efforts as Surgeon General. In targeting reduced tobacco and nicotine use and obesity, the Surgeon General has identified the two leading causes of disease and death in the United States.  Addressing them more effectively will result in improved health outcomes and quality of life for millions of Americans.  The Advisory Group urges the Surgeon General to consider the constellation of approaches to addressing tobacco and nicotine use and obesity as a lens through which all sectors in American society can better understand how to use the four strategic directions of the National Prevention Strategy (healthy and safe community environments, empowered people, elimination of health disparities, and clinical and community preventive services) to improve the health of the nation.

Recommendation 2: Accountable Health Communities

In our last set of recommendations, we encouraged the federal government to use a collective impact framework recognizing that to address our most challenging health problems requires interventions on multiple levels with a particular focus on bringing together the range of sectors that can affect health outcomes by both medical and non-medical sectors. We are encouraged by a planned solicitation from the Center for Medicare and Medicaid Innovation to test different models for assuring that beneficiaries’ medical, behavioral, preventive, and health related social needs are addressed through integrated and coordinated systems of care that include affiliations or partnerships with non-medical organizations. While this is an HHS-focused initiative, to demonstrate improved health outcomes its success will depend on the collaboration of programs across the federal government – from housing to education to transportation.

The Advisory Group urges the National Prevention Council to actively engage with the Center for Medicare and Medicaid Innovation to assure that as communities respond to the solicitation to identify models that address beneficiaries’ health-related social needs, all federal partners are prepared to help ensure successful partnerships and collaborations so that local resources can be accessed to most effectively improve the lives of their residents.  These grants could serve as a model for future public and private multi-sector collaboration.

Recommendation 3: Chronic Absenteeism

The National Prevention Strategy recognizes the close relationship between health and education and their relationship to achieving equity. Children who are not healthy cannot learn well and children who do not complete their schooling are less likely to be healthy throughout their lives.  The Advisory Group was the catalyst for the formation of a National Collaborative on Education and Health, which is addressing an array of policy issues that tie these two sectors together.  A new area of focus – a priority of the President’s My Brother’s Keeper Initiative – is to address the problem of chronic absenteeism when a student misses too much school, whether excused or unexcused. Chronic absenteeism is an early warning signal predicting success in school.  Reducing rates of chronic absenteeism will obviously improve education outcomes (and thus long-term health outcomes), but it can only be decreased if the multiple factors contributing to chronic absenteeism are also addressed – ranging from poor physical (such as asthma), oral (such as chronic tooth decay), and behavioral health issues (such as the impact of trauma) to the lack of transportation and physical safety concerns in school or on the way to school.

While a significant number of federal agencies are already engaged in My Brother’s Keeper, the Advisory Group recommends that the members of the National Prevention Council engage in the effort to amplify the impact of the federal government’s leadership and assure interagency collaboration and action to improve attendance especially among the school children most at risk.  We recognize that school policies are very local and state based, but the federal government, and public-private partnerships like the National Collaborative on Education and Health can be the catalyst for greater impact at the community level.

Recommendation 4: Lifestyle Intervention

The Centers for Disease Control and Prevention estimates that 86% of the $3.0 trillion spent on health care in the U.S. is for treating chronic diseases.  Increasing scientific evidence from randomized controlled trials and demonstration projects is showing that comprehensive lifestyle changes (including optimal nutrition, exercise, stress management, and social support) may slow, stop, or even reverse the progression of many chronic diseases such as coronary heart disease and type 2 diabetes; reduce the need for medications; and help achieve the goals of better health care for more Americans at lower cost.

The Advisory Group encourages the Surgeon General, the National Prevention Council, and the Center for Medicare and Medicaid Innovation to identify and promote best practices and supportive policies to advance the use of lifestyle  interventions, including optimal nutrition, exercise, stress management, smoking cessation, and social support, in the treatment and management of chronic diseases.  Beneficial lifestyle interventions can complement or provide an alternative to medications or surgical approaches for optimal health, including preventing and treating chronic diseases and preventing people living with chronic diseases from developing complications.  Identifying effective strategies to promote beneficial lifestyle interventions is particularly important among populations with the greatest burden of disease.

The advisory group submitted its Fulling the Legacy Report on December 20, 2016.

Download the Fulfilling the Legacy Report (PDF - 550 KB).