Community Health and Economic Prosperity: An Initiative of the Office of the Surgeon General

The health of Americans is not as good as it could be. Despite substantial health care expenditures, US health outcomes are worse than those of most other high-income countries. In 2016, the United States ranked 27th in life expectancy among the 35 Organization of Economic Cooperation and Development (OECD) countries, ranked 32nd among OECD countries in infant mortality, and had the highest prevalence of obesity among 32 OECD countries with obesity data.¹ The poorer relative health status in the United States compared with other OECD countries is a burden on the economy and creates costs and challenges for individuals, families, communities, and businesses. For example, too many jobs are unfilled, and productivity is adversely affected by chronic diseases and behavioral health disorders.^2–4 Many of these problems are rooted in inadequate investments in prevention and unequal economic opportunities in our communities.^5–7

To improve the health of Americans and help foster a more sustainable and equitable prosperity, the Office of the Surgeon General is implementing a multipronged initiative, Community Health and Economic Prosperity (CHEP; Figure).⁸ The goals of this initiative are to increase awareness of the connection between health and prosperity, provide tools and resources for community investment by business and community leaders, and build support and action by multiple stakeholders to achieve the stated goal of building a healthier, more prosperous nation. In this commentary, we discuss the rationale for CHEP, its goals and approaches, and potential benefits and challenges. We argue that the CHEP initiative, in the context of various aligned initiatives, has the potential to improve the nation’s health and prosperity.

CHEP strategies designed to achieve these goals include the following:

1. Develop and publish a Surgeon General’s report on community health and economic prosperity that will synthesize existing evidence on the health–prosperity relationship, make the case for business investment in communities to improve health—including public and private policies that advance employee and community health—and provide exemplars, tools, and resources for businesses that wish to engage in their communities.

2. Convene community, business, and health leaders to explore issues that reflect the challenges and opportunities communities face, such as opportunity youth (ie, young persons aged 16-24 who are not employed, in school, or in training), Building Healthy Military Communities⁹ (a pilot initiative of the US Department of Defense), the power of collaboration (across sectors such as public health, business, and community development), achieving health and opportunity for all, and the needs of low-wage workers.

3. Implement an outreach strategy so that government and partners can share information about the Surgeon General’s report and build anticipation of the report among partners.

4. Use media and communications tools to publicize CHEP activities to reach diverse stakeholders and help build a national movement.

The CHEP initiative joins myriad efforts in communities across the nation that are striving, in one way or another, to improve health and increase opportunity for all Americans. For example, the Robert Wood Johnson Foundation’s Culture of Health¹⁰ and Culture of Health for Business¹¹ seek to place well-being at the center of every aspect of our lives and remind Americans that we are all in this together. Aetna Foundation’s Cultivating Healthy Communities efforts¹² address the factors outside the physician’s office that affect a person’s health and life expectancy. Shaping Our Appalachian Region is engaged in “creating a future in Appalachia. Together.”¹³ The California Endowment’s Healthy Communities investment is dedicated to transforming 14 California communities devastated by health inequities into places where all persons and neighborhoods thrive.¹⁴ Finally, Live Well! San Diego and similar efforts aim to help communities build better health, live safely, and thrive.¹⁵ What ties these efforts together, in addition to their focus on health and economic opportunity, is a recognition that health happens in communities and is tied to the community environment, such as the quality and availability of housing, education, and jobs.^7,16–18 What sets the CHEP initiative apart from these other initiatives is its focus on businesses and the private sector as agents of change to make communities healthier.

Figure.

Schematic of the Office of the Surgeon General’s Community Health and Economic Prosperity initiative. Used with permission by the US Department of Health and Human Services.⁸

Businesses have a stake in the communities in which they are located, in the communities where their employees and customers live, and in the communities they serve. The health of these communities can drive the health of the business and contribute to or mitigate the costs of business, such as health care costs, human capital costs (eg, recruitment, retention), and productivity costs (eg, reporting for work, contributing fully while at work).¹⁹ By joining with change makers in the community, including persons involved in public health, community development, planning and economic development, and foundations and philanthropy, businesses can become a powerful force for positive community transformation and can earn a return of value on their investment. As providers of goods and services, employment, and tax revenue in a community, businesses already create value for themselves and for the community. By joining with others and expanding their notion of stakeholders to include employees, consumers, suppliers, and the community, in addition to customers and shareholders, businesses also participate in the creation of shared value. Shared value “involves creating economic value in a way that also creates value for society by addressing its needs and challenges.”²⁰ It is a social good, and it is good for business.²¹ Businesses are increasingly recognizing that employees and consumers expect businesses to give back and do good, and doing so can enhance brand and strengthen employee and consumer loyalty.²²

The CHEP initiative will demonstrate just how expensive the status quo is to Americans, communities, businesses, and employers. Poverty, lack of education, incarceration, medical care, and pollution are all expensive, and they increase health and economic costs, including costs for businesses. The United States has an excess of poverty and low educational achievement and a high prevalence of incarceration, much of which is avoidable.²³ The CHEP initiative will propose solutions, spreading the word from one business and community to another about how to reduce the costs of these local conditions by making individuals, communities, and businesses healthier. Businesses in the business of offering medical care and health insurance have been at the forefront of this work, recognizing that keeping persons healthy and improving patient outcomes requires interventions that differ from delivering medical care services.²⁴ For example, Geisinger, a health care provider that serves parts of Pennsylvania and New Jersey, implemented community programs to address food insecurity, housing instability, and economic hardship and was able to reduce the need for medical care.²⁵ Cigna, a global health services company, partnered with local businesses and community leaders to address health-related social needs (eg, transportation) and provide schoolchildren with meals to take home for the weekend.²⁶ United Healthcare has invested in housing for the homeless and low-wage workers.²⁷ All 3 businesses recognize the role that community conditions play in promoting health and have taken action to modify those conditions.

Medical care companies and insurers are not the only businesses with a stake in community health and the ability to make a difference. Many companies make the connection between the needs of their employees, employees’ families, and customers on the one hand and the features of the places where their employees, families, and customers live on the other hand. For example, Target Corporation invests in education and safety in each community in which it has a store, particularly in its hometown community in the Twin Cities.²⁸ Belden Industries achieved success with an innovative program to solve a business problem (ie, too many vacant positions) and a community problem (ie, opioid misuse). In partnership with community leaders and services, the company supports treatment for prospective employees and employs persons who complete treatment, helping to reshape community norms and opportunities.²⁹

The aim of the CHEP initiative is not just to encourage business, community, and health leaders to meet the immediate needs of individuals so they can perform better on the job or better manage their chronic conditions to avoid costly medical interventions. The CHEP initiative also focuses on preventing those needs from arising in the first place or solving them permanently and sustainably when they do appear. Accomplishing this goal requires looking beyond public health and medical care strategies and into the strategies of community development and economic policy. Some of the biggest wins for communities, businesses, and health come in the form of affordable housing, adequate incomes, robust job skills, quality education, and access to healthy foods and safe places for physical activity.^30,31 With these ideas in mind, many businesses and communities are working to raise the minimum wage, invest in housing for low-wage workers and their families, provide paid leave, offer early childcare and education services, and improve the quality of local schools.^32–39 Although some of these investments may provide a financial return, others return value to the community and partnering businesses. As noted previously, creating shared value is one of the roles of the business enterprise in a market system.

Although additional work is needed to fully establish the health and economic benefits of these policies, investments, and programs, private-sector engagement is the foundation of the CHEP initiative. The Surgeon General’s upcoming report on this topic aims to build demand and engagement from businesses, employers, and the private sector for the kinds of investments and policies that will enable employees and community members to be healthier and help the communities in which they reside to be more vibrant and prosperous. Adopting policies and investing in communities to improve health have always been important, evidence-based prevention strategies.⁴⁰ But as a society, we have generally lacked the willingness to implement them robustly. Making the case that these prevention strategies are also effective business strategies that can improve individual and community health and well-being, lead to greater productivity and economic prosperity, and create shared value for all stakeholders should increase demand for and resources to support these actions.