PBS高端访谈:美国应尽早投资于健康事业

 　　JUDY WOODRUFF:Much of the national focus on improving health care has centered on the expansion of coverage 1 that's starting to take effect. But a report out today says it's time for the country to pay more attention to the socioeconomic conditions that play a role in health outcomes, especially for lower-income Americans.

　　The recommendations, issued by a nonpartisan commission created by the Robert Wood Johnson Foundation, call for new investments like pre-k education for children under 5.
　　David Williams is a professor at Harvard's School of Public Health. He was a staff director for the commission as well.
　　And, for the record, the foundation is one of our sponsors for health coverage.
　　Professor Williams, it's good to have you with us.
　　DAVID WILLIAMS,Harvard School of Public Health: It's good to be with you.
　　JUDY WOODRUFF:So what is the rationale for thinking that doing something about socioeconomic conditions is going to be connected to a health improvement?
　　DAVID WILLIAMS: Well, first, the larger context is, as a nation, we have a huge problem. We spend more money on medical care than any other country in the world.
　　According to the World Bank, half of the money spent on medical care in the world annually 2 is spent in the United States. Yet we rank among -- at the bottom of the industrialized world on health and we are losing ground over time. So we have a crisis. And the problem is not just a problem of the low-income individuals and the poor.
　　Even the best-off Americans are not currently achieving a level of health that is possible. And more medical care spending will not solve it. We now need to look at what are the drivers of health in the first place.
　　Our health care system is wonderful. We have great facilities. We have the best-trained medical work force in the world, but to a large degree, medical care is a repair shop that takes care of us once we get sick, and it doesn't determine whether we get sick or not in the first place.
　　JUDY WOODRUFF:So, what is an example of something that can be done to improve someone's what we call socioeconomic status, whether it's education or something else, that then leads to an improvement in health?
　　DAVID WILLIAMS: So, let's talk about early childhood development.
　　What we know is that the foundations of health in adulthood 3 are laid in childhood. And the opportunities and the experiences that children have even before they go to school shape their risk of chronic 4 disease 30, 40 years later, so that everything that we can do to prepare those children and give them the optimal 5 health and optimal developmental opportunities in the preschool area, then they're ready for school, and they have high levels of education, and they will have better health for the rest of their life.
　　JUDY WOODRUFF:But can you give us an example of something they would learn in school that would then lead to a better health outcome?
　　DAVID WILLIAMS:Certainly, more health education and more physical fitness in school are good, but that is not where I'm going.
　　We're going on preparing those kids for learning. So, for example, a child exposed to toxic 6 stress -- and toxic stress are examples of being taken care of by a caregiver who is chronically 7 depressed 8, growing up in chronic poverty, being a victim of abuse -- that child will have more problems in success in school, but will also have more health problems as an adult.
　　Studies show that we can actually measure the alteration 9 of brain structure in those preschool kids linked to their exposure to toxic stress.
　　JUDY WOODRUFF:At the same time, I was reading today that, of course, there is disagreement among experts about whether universal pre-K education, which is one the things I think your task force is calling for, is good for all children.
　　How do you look at the arguments that are out there about this?
　　DAVID WILLIAMS:I think every child needs the opportunity for healthy development.
　　For many children, they may get that in the home. And they don't have to go to a preschool setting. So we are not necessarily calling for preschool -- universal preschool for all. We are calling for universal preschool for those who are in environments where they need that healthy environment to do well.
　　And that certainly characterizes many of our lower socioeconomic populations.
　　JUDY WOODRUFF:Looking at -- looking again at some of your recommendations, it's a pretty ambitious agenda. How do you pay for it?
　　DAVID WILLIAMS:That is a really good question.
　　Given our expenditure 10 on medical care, this money is not -- there isn't a shortage of money in this country. The question is, how do we spend our money and what are our priorities? But the good news is, there are promising 11 models all across the country right now with creative public-private participations, like in the state of Minnesota, where the business community and the state has come together to provide scholarships so that all poor kids can get a preschool education.
　　Or there's an example from Texas where the state raised the sales tax by one-eighth of a penny, and that money is allocated 12 for preschool education. So there are wonderful examples.
　　JUDY WOODRUFF:So, you are saying the evidence is already out there that this works?
　　DAVID WILLIAMS:Let me tell you how powerful the evidence is.
　　The best evidence comes from a study done in Ypsilanti, Michigan, more than 50 years ago, the Perry Preschool study, where kids were randomly 13, by the flip 14 of a coin, received preschool or didn't receive preschool. They have now been followed for 40 years. Those kids that got the preschool, 40 years later, higher levels of education, higher levels of income, higher levels of home ownership, higher levels of marriage, less involvement with the criminal justice system, less involvement with the social welfare system.
　　And for every dollar invested, there is a $17 return to society from that preschool program. That is stunning 15. That is amazing economic development that we can achieve.
　　JUDY WOODRUFF:So, just very quickly, finally, is this something you have to persuade the White House and the Congress to go along with to make it happen?
　　DAVID WILLIAMS:I think there is a lot of interest in pre-K education across the political spectrum 16 in the United States now, because the evidence is so strong that there is such enormous benefit for our society.
　　JUDY WOODRUFF:All right, Professor David Williams of Harvard, we thank you very much.
　　DAVID WILLIAMS: Thank you.