I've experienced the reality of health differences. In the 60s and 70s, growing up in Boston’s low-income, mostly black communities, my family couldn’t get it, or frankly, privileges were exploiting the depth and richness of the Massachusetts healthcare system. We paid the price for it. My stories are not uncommon. This is what countless others respond to.
Health differences are not new and have spanned centuries. In my life alone, we have seen a wave of solutions to them: the creation of federally qualified health centers under the Economic Opportunity Act of 1964; the introduction of Medicare and Medicaid in 1965; the surge in research in the 1970s; the establishment of the Minority Health Office in 1986; the Defensive Minority Health Act of 1990; the NIH Revitalization Act of 1993, which is just a short list. State, federal and academic initiatives have poured time and resources into understanding and resolving these gaps. The persistence of these problems, in some cases, is not due to the lack of attempts.
So, why don’t we achieve real lasting progress? Why can't we stay around health differences and squeeze them out? There isn't an answer, but I think three culprits stand out: we lack common language, clear accountability and defining metrics of success.
Let me draw a picture with some examples. Back in the early 1930s, American companies' sloppy, inconsistent financial reports were seen as a key trigger for the 1929 stock market crash and the subsequent Great Depression. The American Institute of CPA's American Institute stepped in and created GAAP, a set of accounting standards that brought consistency, predictability, and transparency. Clear purpose, common language, accountability and measurable results turn confusion into order.
In 1961, President Kennedy abandoned a glove: climbed a man at the end of the decade and defeated the Soviet Union in the space race. Skeptics call it a daydream, but with clear goals, deadlines and ruthless sense of responsibility, galvanized NASA and a bold vision of state support. Neil Armstrong's first step in July 1969 proved that this was not a fantasy. This is the point.
In 1964, American surgeons abandoned a bombshell report to link smoking to serious health risks. Within one year, the Federal Cigarette Labels and Advertising Act stipulates warning labels on packaging. Following the reasons for laws, taxes, regulations and public movements, smoking rates in a lifetime have been cut by about 75%. A direct goal, clear indicators and coordinated driving force achieved results.
Then in 1987, President Reagan stood at the Brandenburg Gate and asked “Mr. Gorbachev to remove this wall.” A clear goal, defined result and sense of responsibility, shocked the world. Two years later, the Berlin Wall fell.
Now, some would say that health differences rooted in centuries of inequality are trickier than sorting out accounting rules, landing on the moon or tearing down the relics of the Cold War. They are not wrong. But complexity is not an excuse to stagnate.
Taking one of the Ministry of Health and Human Services’ roadmaps to improve health conditions across the country, take Healthy People 2030 as an example. It outlines five ambitious goals: ensuring that a thriving life is free from preventable diseases and premature death, removing gaps and achieving healthy equality, building a healthy potential for unlocking everyone, promoting a healthy environment at all stages of life, and promoting well-being at all stages of life, and bringing together leaders and the public to take action. No doubt, noble goal. But they were followed by 358 targets, some ambiguous, some tangled, and even conflicted, as well as overlapping authorizations from various HHS agencies. Good will often be lost in this complex ocean.
To cut noise, we need an action plan. Efforts to unify the country by appointing the “Health Disparity Tsar”. A leader, a vision, a streamlined, cost-effective and coordinated approach, not the mess we are now fragmented. From there, we are unable to solve the entire “health difference”. It is crucial to prioritize five to seven key differences over the next decade. I first want to start with maternal mortality, heart disease, diabetes, obesity, and several other areas where we can narrow down. The key is the focus, not the “boiling ocean”, but the key issues.
To make real progress, we must abandon vague cliches and set smart goals: concrete, measurable, achievable, relevant and time-limited. It has nothing to do with wishful thinking; it is about specific targets we can track and hit. I’m all about improving local health and well-being, but without a unified national framework, we’re just talking. Looking at past successes such as GAAP, Moon landing, Reducing Smoking and the Berlin Wall, everyone has succeeded as clarity and accountability turn ambitions into action. Health differences should be. My story and the dangers of millions of people like it. We have the tools and will; now is the time to improve our goals and achieve them.
Photo: Peterpencil, Getty Images
Jason Robart is co-founder and managing partner of early stage venture capital firm See Ventures. Prior to co-founding SEAE, Mr. Robart served as Chief Strategy Officer of Blue Cross Blue Shield, Massachusetts, and President and CEO of Zaffre Investments, a wholly owned subsidiary of Blue Cross Blue Shield, Massachusetts.
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