National Academies’ Report Yet Another Wake-Up Call For Health Grantmakers To Fund More Domestic Advocacy

posted on: February 21, 2013

By Sean Dobson
Image courtesy of TakeAction Minnesota


A new report by the National Research Council and Institute of Medicine of the National Academies (NA) bluntly titled U.S. Health in International Perspective: Shorter Lives, Poorer Health, notes that American lives are markedly shorter and unhealthier than those in other high-income countries – and the problem is getting worse. This American disadvantage “is particularly striking given the wealth and assets of the United States and the country’s enormous level of per capita spending on health care, which far exceeds that of any other country.” (p.4)

These facts have been well known for so long that nowadays even conservatives (at least the few who still heed science) grudgingly concede them. What’s new in the report is its demolition of the standard conservative alibi explaining poor U.S. health performance. “The U.S. health disadvantage cannot be attributed solely to the adverse health status of racial or ethnic minorities or poor people, since recent studies suggest that even highly advantaged Americans may be in worse health than their counterparts in other countries.” (p.1)

Also new is the report’s emphasis on the comprehensive nature of U.S. inferiority: “The health disadvantage is pervasive – it affects all age groups up to age 75 and is observed for multiple diseases, biological and behavioral risk factors, and injuries.” (p.2)

The report refrains from positing an overarching explanation for the unhealthy state of our country. However, it hints very strongly that the problem lies not so much in lack of high-end medical research and training or delivery of expensive types of treatment to insured patients, but instead much more because of:

  • Lack of social solidarity that results in a shocking gap in income and wealth.
  • Denial of health care access to millions of our fellow citizens, including children.
  • Inadequate public health efforts.
  • Willful blindness that obvious and massive killers such as auto accidents and firearms should indeed be classified as “health” issues.

For lack of a better term, most of these factors fit under the rubric of “public health measures”. But the report stops just short of saying so. Instead, its section titled “Possible Explanations for the U.S. Health Disadvantage” breathes that spirit, but cautiously calls for more and better transnational research to test specific hypotheses. (pp. 4-6)

In the meantime, the report exhorts Americans not to sit on our hands and wait for perfect data, but instead to act on the solid knowledge we already have. Two of the recommendations pertain to health grantmakers:

  • “The nation should intensify efforts to achieve established national health objectives that are directed at the specific disadvantages documented in this report and that use strategies and approaches that reputable review bodies have identified as effective. “ (p.8)

    The most obvious way to “achieve established national health objectives” would be full implementation of the Patient Protection and Affordable Care Act (ACA). NCRP shows grantmakers how to fund ACA implementation in this report. And we teamed up with the California Endowment and others to provide guidance to grantmakers on this topic in this archived webinar.

  • “The philanthropy and advocacy communities should organize a comprehensive media and outreach campaign to inform the general public about the U.S. health disadvantage and to stimulate a national discussion about its implications for the nation.” (p.8)

    It is hard to imagine our country upgrading its decrepit health system without first alerting and educating the American people about the severity of the problem while also rebutting conservatives’ know-nothing insistence that “American Exceptionalism” entitles us to ignore evidence from outside our borders.

In essence, the report does not ask philanthropists to continue the business-as-usual funding of construction of ever more cancer wings at elite hospitals and ever more lecture halls at elite medical schools. Instead, it mostly asks them to invest more in advocacy to promote reform, public education, and public health measures (a plea I made in a past blog essay).

The takeaway for health grantmakers is much larger than these two recommendations. The report constitutes nothing less than a scathing indictment of the entire U.S. health care system – an indictment that must also include health philanthropists.

Who in philanthropy, faced by this report, can dispute that we have been part of an epic failure decades in the making? Too many health grantmakers have been complicit in the refusal of the entire sector to fund more advocacy to attack the root causes of social problems, including our health care crisis.

Numbers from The State of Social Justice Philanthropy show a modest uptick in recent years in institutional funding for advocacy from 12 percent up to 15 percent of grant dollars overall (the increase only goes to 11 percent for health grant dollars). Clearly, this is not nearly enough for our country to correct such a huge dysfunctional health care system.

How will we know if health grantmakers have heard this report’s booming wake-up call? A good initial sign would be lots of discussion about the report (and self-criticism) at the next Grantmakers in Health conference.

Sean Dobson is field director at the National Committee for Responsive Philanthropy (NCRP).