Last week, I was fortunate to meet with a group of health providers representing some of the best-and-brightest, most innovative delivery systems in the U.S. The subject was innovation, and as I presented a forecast of scenarios for health reform, the conversation inevitably moved to the subject of how to manage health costs if/when we add the uninsured into the American health insured population.

There is a typical response to this question that many of us pull out of our health-econ PowerPoint deck: that “we’re” already paying high costs for this population in the form of emergency room visits and higher-costs to the system when people enter the system later and sicker. Thus, by covering the uninsured before they get sick, or sicker, we can avert more expensive interventions required later in the illness cycle.

“But wait, there’s still more,” we brainstormed! There are several factors that are bad for our health that are beyond health system and provider control and, for the most part, influence: the role of Big Food, the malling of America, and sedentary, technology-based entertainment.

As for Big Food, a Fast Company essay called “Devil’s Food” published last month offers a nice wrap-up of the current state of food consumption and tastes in America. Prior to writing her column, Elizabeth Spiers had just consumed a large portion of Jelly Belly Sport Beans, containing carbs, electrolytes, vitamins B and C, and so-called “natural flavor,” she writes.

The Hardee’s Monster Thickburger, launched in 2004 and pictured above, is but one overt example of Big Food. The stats on this baby could whet the appetite of stent marketers: 1,420 calories and 107 grams of fat. The fat is derived from two one-third pound burgers, 4 bacon strips, 3 slices of American cheese, and mayo, assembled on a buttered (!) bun.

In her column, though, Spiers isn’t talking about anything as obvious as Big Burgers. She’s reporting on the trend toward consuming seemingly healthy foods like New Drinks. VitaminWater – owned by Coca-Cola – and health-labeled goodies such as Laura’s Wholesome Junk Food Chocolate X-Treme Fudge Bite-lettes, sold at Whole Foods, demonstrate Spiers’ point that “Big Food wants everything bad to be good for you.”

But, she notes, the two main ingredients in Sport Beans are sugar and corn syrup.

It’s not only Big Food militating against our health, and outside the direct influence of health providers. We’re a nation of shoppers, and how we shop has a lot to do with How We Look and Feel. The strip-malling of America, and exurbanization of community-building, isn’t good for Main Street walking. For some people, the only exercise they get in a day is parking a few meters from Wal-Mart and traversing the aisles.

And then there’s the way we consume entertainment: sedentarily, via technology, often alone.

The popularity of the Nintendo Wii at the holidays is one very small step — for health. It’s being adopted in rehab centers and sporting households around the country. A study published in the British Medical Journal found that Wii players use significantly more energy than playing sedentary computer games. However, the energy used when playing Wii games won’t contribute towards the recommended daily amount of exercise in children. For the mainstream, then, it’s no substitute for a good walk around the block.

Health Populi’s Hot Points: Health reform in the U.S. is as much about these seemingly exogenous factors as it is about doctors and hospitals, insurance companies and pharma. This time around, let’s get the players who can influence health for the good around the reform table, too. Take a look at your kid’s school lunch program, and the proportion of overweight kids in her school. You’ll get my point. Alice Waters of the reknowned Chez Panisse in Berkeley, California, has gotten involved in the city’s school lunch program. So has Jamie Oliver, British rebel-chef, in the UK schools, in the interest of health and The Good Life.

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