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Originally published Monday, December 22, 2008 at 2:55 PM

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Health care reform must focus on individuals too

President-elect Barack Obama's pledge to tackle health care must include changes at the system level and at the individual level. That's why efforts to reform America's health-care system must include a federally supported social-marketing campaign to address obesity and prevention.

Special to The Times

WHEN President-elect Barack Obama won the 2008 presidential election, he did so with an overwhelming mandate for change. In his acceptance speech on Nov. 4, he pledged to listen to the American people — but he also said he would ask the public to join in the remaking of this nation.

If the issue of health care is any indication, our president-elect is making good on that promise. And it couldn't come at a better time. Despite spending more on health care than any nation, the United State lags behind most of the Western world on leading health-care indicators. The problems in our nation's health and health care lie at both the individual and systemic levels — and both must be addressed.

In its recently released America's Health Rankings, the United Health Foundation reported that Washington State has moved up to No. 10. It was great news, but it also showed the very challenges our state faces are the same health problems gripping the nation.

Obesity rates are skyrocketing. Here in Washington, obesity rates are up 176 percent since 1990. The American Obesity Association reports that more than 30 percent of children between the ages of 6 and 19 are overweight — and more than 15 percent are obese.

The longterm health outcomes associated with high stress, sedentary lifestyles and poor eating habits are staggering: increased likelihood of coronary heart disease, type 2 diabetes, stroke, high blood pressure, and much more.

That's why efforts to reform America's health-care system must include a federally supported social-marketing campaign to address obesity and prevention. It should be equal in commitment, scale and intensity to the smoking-cessation campaigns that have led to drop in tobacco use in Washington and some other states.

Rising health-care costs are also hurting America's health. It is estimated that upward of 45 million Americans go without health insurance at any given time — meaning they go without regular checkup and preventive care, only visiting a doctor when an emergency strikes. Approximately 25 percent of those without insurance are eligible for health coverage through Medicaid or through the State Children's Health Insurance Program — but they haven't enrolled. Reform efforts must incentivize states to simplify enrollment procedures and eliminate bureaucratic barriers to health care.

And medical care must focus on prevention, early detection and proper management of chronic diseases such as asthma, cancer, diabetes and heart disease. These conditions account for an estimated 75 percent of all health-care spending. Currently, Washington is in the bottom half of all states, ranked 32nd, when it comes to use of proven preventive care.

Since 2004, my organization, the Washington Health Foundation, has worked across sectors with consumers, providers, schools, government and all types of businesses to promote personal responsibility, prevention, and early disease detection and management. We've built a movement of organizations, schools and individuals who know that we can improve our health by working together to promote personal responsibility and build collective action.

President-elect Obama's administration is a tremendous opportunity to usher in a new era of change — and we are leading the way here in Washington, having improved our state health ranking from No. 15 to No. 10 in just four years. It is now up to all of us, in Washington state and through this nation, to hold our leaders accountable to the mandate for change — to demand that policy and political action be taken to improve health at this crucial moment in our country's history.

Greg Vigdor is president and CEO of Washington Health Foundation, a nonprofit organization leading the way in making Washington the Healthiest State in the Nation.

Copyright © 2008 The Seattle Times Company

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