As President of the United States, first, I would implement all possible health promotion strategies. Food stamps would cover nutritious food — only. People could buy junk food and chemical drinks if they wish, but not using food stamps. Breastfeeding initiatives similar to those in Arkansas would be expanded. WIC would not supply formula to newborns the first two weeks (to avoid sabotaging breastfeeding in our most vulnerable population. Mothers who prefer not breastfeeding would easily obtain formula from manufacturers' coupons and samples mailed directly to their homes.) All hospitals would be encouraged to earn the prestigious "Baby Friendly" designation.
In schools, the only between-meal beverage would be water — abundant fresh cool water. In addition to the Presidential Fitness Awards, I would institute the First Lady's Nutritional Fitness Award — for students, classes, and schools. From Head Start and Pre-K through high school, I would request an integrated comprehensive health education curriculum, emphasizing practical skills — tooth-brushing, balanced meal preparation, safe home remedies — and fostering respect for scientific evidence — to develop competent healthcare consumers, resistant to misinformation. Harking back to my own school days, as student and as teacher, recess would be mandatory for all children, twice a day for lower grades. (Research supports greater achievement with regular recesses.) Every student would take physical education every semester. Adaptive-PE would be substituted for those children unable to participate in regular classes. Part of everyone's physical education, would be stress management practices.
Successful students are happy students who want to progress to the next level. Failing children just want to escape the pain. Because so many healthcare dollars go for treating mental health and substance use, I would do everything possible to keep young people happy and in school. I would employ simple measures like changing the bus schedule to start high school later in the day (simultaneously increasing achievement and decreasing the amount of trouble teenagers get into). I would insist schools' curricula be developmentally appropriate for boys and for girls, who mature at different rates. I would reward schools for teaching sound foundation skills before launching into frustratingly abstract subjects. Consistent with the goal of promoting mental health and academic success, I would make every effort to educate the public about effects of TV and video on children; I would require media producers to meet the same level of public safety as other recreational products. Because ADHD across the lifespan is so widespread and costly, I would take aggressive action to prevent or lessen it, actively fostering: lifestyle management, including sleep, nutrition, and healthy recreation; avoidance of prenatal tobacco and other toxic exposures; and marked curtailment of TV/video time in developing youngsters.
Early Intervention for babies at risk of developmental disabilities would return to the medical model of proper diagnosis followed by appropriate treatment — as opposed to non-specific therapies for "delays," the etiologies of which have not been elucidated — or services postponed until the child is significantly disabled, enough to "qualify," but which stage need never be reached with early intervention to prevent such progression to the handicapped state. Similarly, elementary schools would emphasize immediate help to those at risk of failure, and would use neuroscience as the basis of diagnosis and treatment, rather than "eyeballing" children or giving all struggling students the same intervention and requiring that they fail to respond before instituting neurologically sound, individualized treatment modalities.
Dyslexic children can have normal MRIs by middle school if they get proper treatment starting in first grade. If we waste the window of opportunity retaining students in the same grade instead of teaching them, we end up with low-achieving drop-outs engaging in documented levels of high-risk health behaviors. Among other preventable — and expensive — morbidities, we reap chronic debilitating mental illness in a substantial number of those drop-outs.
Continuing with health promotion, I would employ proven programs like needle exchanges and condom distribution to limit the spread of HIV, hepatitis, other blood-borne and/or sexually transmitted diseases. I would use other evidence-based strategies: pay teens to attend prenatal classes and stop-smoking programs, send visiting nurses to monitor the elderly with health problems, use more nurse-midwives, and support practical home-based care. I would insist on strict enforcement of "truth in advertising" for all health-related products and services, including food, beverages, nutritional "supplements," recreational items, and standard and alternative therapeutic interventions and products. Companies would be required to provide actual scientific evidence to support health claims, stated or implied.
I would charge the CDC with tackling serious public health issues including alcohol, tobacco, and firearm safety programs — from selling all guns with safety locks to coordinated background checks for all automatic weapon transactions. From testing (anonymous) group urinary cotinine levels (to target smoking interventions in schools and institutions) to designing abundant affordable alcohol and drug treatment programs, with in-patient availability for when out-patient fails. Mental health would be part of every program, besides constituting many specific CDC-targeted health conditions. A select bipartisan committee would convene monthly at the White House to address specific national health issues with both leading experts and representative stakeholders. The committee would adjourn when they had a meaningful recommendation to present to the nation.
Next, I would structure Medicaid funding such that the higher proportion of a state's eligible population enrolled, the higher proportion of that state's Medicaid funding the federal government would supply. I might sponsor a "Race to the Top in Health" at the state and local level. I would offer a nationwide single-payer option and provide enhanced Medicare availability to younger seniors. I would definitely reward improved efficiency but not at the expense of the patient or doctor. I would eliminate redundant paperwork; with EHR I can transmit prescriptions electronically but must physically fill out informed consent forms to give patients or fax to pharmacies — because my simple prescription isn't enough for some insurances. I must also justify my choice of drug, describe my planned course of treatment and document that I have taken all precautions and explained every eventuality to my patient — every single time. (God help me if I order anything other than the cheapest generic.) I would insist on a respectful balance between "best practices" (determined by statistical analyses of populations) and clinical judgment by the treating physician (and not some insurance company's computer algorithm; even when it is outdated or just plain wrong, the algorithm always wins).
Because it's so embarrassing when foreign visitors are shocked and dismayed at the high cost and uneven availability of healthcare they take for granted back home, I would eagerly implement "Obamacare" in hopes of America improving our standing in healthcare among developed nations, and gradually perhaps adopting a rational approach to healthcare financing.
Finally, I would introduce annual Good Health Day. All citizens would be canvassed for health needs and offered relevant health services, especially cheap/free ones. Community volunteer groups would gather and aggregate the data. Each organization offering health services would describe them in a directory widely accessible — online, by phone, at the library, through governmental agencies and schools — advertised as a public service on public transportation, local cable and other community venues. Respected civic leaders would "vet" the concept — and the process at the neighborhood level — to ensure safe, comprehensive participation. Nationwide promotional gimmicks would be shamelessly employed — whatever it takes — to demonstrate benefits and generate enthusiasm for this project connecting everyone with their chosen health-promotion activities.
Helene Hubbard, MD, is a developmental-behavioral pediatrician based in Florida for more than 20 years. She taught kindergarten through graduate school for nearly 20 years before attending medical school. She holds a Ph.D. in educational psychology.