Health care reform recommendations, core tenets and “solutions” abound from every stakeholder group (a Google search returns more than 20 million references). Here’s one that’s worth a closer look.

Robert Wood Johnson Foundation (RWJF) lists six elements for comprehensive reform:

1. Cover the uninsured.
2. Improve the quality, value and equality of health care.
3. Bring down spending.
4. Prevent disease and promote healthier lifestyles.
5. Strengthen public health’s capacity to protect our health.
6. Address the social determinants of health.

Simple, optimistic and evidence-driven. And, unlike so many proposals that go after the symptoms of cost and coverage, RWJF’s blueprint recognizes that our health is connected to a broader, complex and interdependent system of forces that go beyond medical care.

The veil has been lifted on “the true causes and real cures,” says Risa Lavizzo-Mourey, M.D., in her President’s Message from the 2008 RWJF Annual Report. “Not knowing is no longer an excuse for inaction” to address “the full continuum of interconnected factors” linked to health and health care.

The “problems are too intricately interwoven to compartmentalize,” she notes. So, where to start?

Like most reform proposals, RWJF’s begins with health insurance coverage for all. We must get underneath the “chronic social and political malfunction that the economic meltdown compounds daily,” writes Dr. Lavizzo-Mourey. This is triage for what the Institute of Medicine estimated in 2004 to be nearly three American deaths every hour linked to lack of insurance.

Examining and redirecting spending also tops RWJF’s list: “The ‘value gap’ between what we spend on care and what we get in return is a fundamental cause of America’s joined health care and economic crises.”

For instance, while almost 95 cents of every health care dollar is spent treating those who are already sick, only about 2 cents goes to prevent illness. One study found that a $10 per person annual investment in community-based prevention over five years could produce 5 percent reductions in type 2 diabetes, high blood pressure, heart and kidney disease, and stroke — with an estimated ROI of $5.60 for every dollar invested.

Another study showed that for each 10 percent increase in public health spending, mortality rates fall as much as 6.9 percent. In one example, health policy experts calculate that it would cost eight times as much to achieve the same outcome through medical care than it would through public health investment.

The biggest difference in RWJF’s proposal is the inclusion of non-clinical social forces affecting health, which, Dr. Lavizzo-Mourey admits, call for heavy lifting over the long haul: “Where we live and work, buy groceries, go to school, who we know, what we earn all shape our behavior and health. It will take a lifetime to make a difference, but it must be done in our lifetime.”

In her January 27, 2009, testimony before the U.S. Senate Committee on Health, Education, Labor and Pensions, Dr. Lavizzo-Mourey urged Congress to address the social determinants of health in this year’s reform plans. She draws on compelling evidence and powerful models for change across schools, neighborhoods, and the workplace — “the places where health really happens.”

“The hardiest tests of our national character come when we are called upon to…confront truly ‘tipping point’ menaces to health, security and well-being,” she concludes in her annual report letter. “What has changed is that now we know what to do and how to do it. There is no responsible reason for not acting.”