More racial diversity, greater economic inequality and wider polarization of politics separate contemporary America from any other era in the country’s history, said Kathleen Sebelius, the Obama administration’s former secretary of the Department Health and Human Services.
On Thursday morning in the Amphitheater, Sebelius discussed the impact of healthcare in the growing definition of what constitutes a “livable community.”
“To me, a livable community is really a healthy community for everyone,” she said. “When I use health in that application, I’m not talking about the absence of disease, but physical, mental, spiritual well-being that enables individuals to live and work and prosper to the greatest of extent of their abilities. That’s really what the broad definition of health is.”
The future of livable, healthy communities will see the rise of millennials — those aged 18-34 — and a decreasing number of baby boomers in years to come.
By the end of 2015, millennials will represent around one-third of all Americans, becoming the top age bracket in the country, Sebelius said. Baby boomers will move down to the second spot.
“When we’re looking at [millennials] — the most talented, the most diverse, the most tolerant and the most optimistic generation that we’ve ever had — and they are our new leaders, the possibilities are limitless,” Sebelius said. “I am looking forward to having a chance to participate in some of those discussions but turning over the reins to a new generation of leaders in this country.”
Sebelius’ efforts to implement the Affordable Care Act during her five years at HHS spurred the continuing conversation on healthcare in the millennial generation. Though every American now has the right, rather than the privilege, of accessible healthcare, the concept of healthcare goes outside the traditional system.
In a perfect world, a child would be born healthy as possible, and its parents would have all the necessary resources and information to properly raise that child, she said. That world does not exist in the U.S. now, as care for more than half of babies is paid for with Medicaid, which indicates that mothers cannot pay for health insurance or are otherwise in cash-strapped jobs.
“We love to say in this country that children are our most important resource,” Sebelius said. “It’s an interesting line, but it really isn’t borne out of the policies that we have in these countries.”
Sebelius cited the underwhelming maternity and paternity policies in the U.S., along with a lack of early childhood education emphasis and options.
Policies don’t rest in hands of bureaucracies dedicated solely to the promotion of health and healthcare, such as HHS, Sebelius said. For example, schools have become the cornerstone of communities where education, social and health services have started to merge to provide a one-stop resource for America’s youth.
At the federal level, agencies across the spectrum have found solutions to support health in communities.
“It is the job of everyone to look at how we have a healthy community and how we have healthy citizens,” Sebelius said. “As agencies came together, they were asked to think about all the assets they had to improve the health of the entire population.”
When 26 agencies met with Sebelius and HHS, they endeavored to strive for a healthier future, she said.
The Department of Housing and Urban Development implemented more smoke-free options and green spaces in public housing. When planning road infrastructure, the Department of Transportation factored in the addition of walking and biking trails. As wholesome foods became harder to come by, the Department of Agriculture promoted the proliferation of green grocers and farmers markets.
In the past five years alone, the progression of livable communities has seen visible results.
“In 2009, the United States spent more than any other country on healthcare — twice as much per capita,” Sebelius said. “[The United States] had more uninsured per capita than any other country, about 40 million without insurance in all, and our health results as a country looked pretty lousy.”
Today, that picture looks drastically different, she said. Those uninsured are down by at least one-third — the largest drop in the country’s history — after two years. Health inflation is the lowest it has been in 50 years, and obesity rates among children are slowly declining.
Yet, Sebelius said, the progress shouldn’t stop there; instead, continued improvements should approach the healthcare system head-on.
“How do we help by the payment system to reward prevention and keep people healthy in the first place and not just focus it on the acute healthcare system?” Sebelius said.
In just the past few years, 7 cents of every healthcare dollar was spent on preventative care compared to the other 93 cents that was used toward acute healthcare, Sebelius said. Smoking and obesity, preventative problems, are the two leading factors that contribute to chronic health problems.
The reduction of early elective deliveries — a process where parents opt for the birth of their child when it’s not medically necessary — was just one example where a progressive approach to the healthcare system could prevent unhealthiness down the road, Sebelius said.
Congress’ hesitancy can be disheartening, Sebelius said, but the federal government isn’t the only institution capable of change. Individuals at town hall meetings and local politicians have the power to change the landscape of healthcare going forward.
“I think we have to get back to that spirit in America of looking down the road and making an investment in a healthy, livable community — and I’m an optimist,” Sebelius said. “Now, I’m Democrat from Kansas, so I have to be an optimist.”
The Chautauquan Daily 
