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A new report says health care costs could be reduced by investing in nutrition, exercise, housing and education programs, and making it more expensive to smoke and drink. The Washington, D.C.-based Trust for America’s Health examined 1,500 programs and then recommended the most effective strategies states could adopt to save money and prevent illness. In 1960, health care spending in America accounted for 5 percent of gross domestic product. But that figure climbed to 18 percent of GDP in 2018. Adam Lustig, co-author of the report “ Promoting Health and Cost Control ,” urged policymakers to read about the strategies to improve health. “Doing so will give them access to proven solutions to the challenge of runaway health care spending yet so little improvement in health outcomes,” Lustig said. “To improve Americans’ health, we have to think beyond the health care sector and about the many factors that impact health.” Local organizations that manage Oregon Health Plan benefits in Southern Oregon have embraced the idea that how people live, work and play impacts their health. They’ve backed programs to improve the so-called social determinants of health. While the term is new, people have known about the importance of healthful lifestyle choices dating back at least to the ancient Greeks, said Sam Engel, social determinants of health manager for AllCare Health, an Oregon Health Plan benefits coordinator. “It’s a lot easier to be healthy than to get healthy,” he said. Only 10 percent of the average person’s health is related to medical care. Biology and genetics influence about 30 percent of health, but lifestyle, behavior, social factors and the built environment account for an estimated 60 percent of health, Engel said. In other words, 90 percent of a person’s health is outside of a doctor’s control, he said. According to the “Promoting Health and Cost Control” report, building sidewalks, bike lanes and parks would help people incorporate exercise into their daily lives — offsetting $117 billion in annual costs from inadequate physical activity, the report says. Preschool education programs generate $4.63 in benefits to society for every dollar spent, yet only nine states provide state-funded education for at least half of their 4-year-olds, the report says. Oregon doesn’t offer universal preschool education, but it does have Head Start and other early-education programs for low-income kids. Southern Oregon Head Start is funded by a mix of donations and funding from the state and federal governments. Among other benefits, investing in early-childhood education reduces the risk of chronic illness, obesity, low academic performance, behavioral problems in school, dropping out, teen pregnancy, alcohol and drug use, violence and unemployment, the report says. The report advocates the adoption of free and reduced school meals programs, plus nutrition standards for meals and snacks. In Oregon, schools can offer free breakfast and lunch to all their students if a certain percentage of their families are low income. Slightly more than half of the Medford School District’s almost two dozen schools participate in the free meals program, said Jeff Ashmun, general manager for Soxedo, a school foods provider. The report says hunger and poor nutrition hurt school performance and lead to more sickness and hospitalizations. The average cost of a child’s stay in a hospital is $12,000. Poor nutrition also contributes to obesity. If current trends continue, half of today’s children will be obese by the time they reach age 35. Obesity costs the nation $149 billion in medical expenses annually, the report says. Syringe exchange programs for intravenous drug users are also cost-effective, the report says. Jackson County offers a syringe exchange program at its Health and Human Services Building, at 140 S. Holly St. in Medford. Providing sterile needles reduces the spread of blood-borne diseases such as HIV/AIDS and hepatitis. Lifetime treatment for one person infected with HIV at age 35 costs $326,500, according to a 2015 study . Depending on the drug used, medication to cure hepatitis C can range from $26,400 to almost $100,000, according to 2018 prescription data. People who visit Jackson County’s syringe exchange program can also get safer sex supplies, addiction treatment referrals, overdose antidote kits and test strips to check for deadly fentanyl in street drugs. Syringe exchange programs don’t lead to drug use and can keep people healthier until they are ready to seek treatment. Reducing the spread of infectious diseases helps safeguard the entire community, including police officers, paramedics, doctors, nurses and others who come into contact with drug users, the report says. The report authors urge states to increase tobacco and alcohol taxes and adopt smoking bans for buildings and public outdoor spaces like parks. Oregon lawmakers are considering a proposal to raise the state tobacco tax from $1.33 per pack of cigarettes to $3.33 per pack. That would boost the typical cost of a pack from $5 or $6 to $7 or $8. Higher tobacco prices especially reduce use among teens, young adults and low-income people, the report says. Smoking costs the United States nearly $170 billion in medical care each year, plus another $156 billion in lost productivity, according to the CDC. Excessive drinking costs the nation $249 billion — or $2.05 per drink consumed. Costs were from lost workplace productivity, medical spending, law enforcement and car crashes, according to the CDC. Adequate housing is crucial to community health, the report says. Providing housing for homeless people can save money by reducing hospital admissions and jail bookings, the report says. However, a lack of housing — especially rentals — in the Rogue Valley and the rest of Oregon means low- and middle-income residents are also struggling to find apartments and houses. The federal government says households are burdened by housing costs if they spend more than 30 percent of their income on housing. Yet many Rogue Valley households are spending 50 percent or more of their income on housing, Engel said. The shortage of housing is having ripple effects across Southern Oregon. Some children have been placed in foster care not because of abuse and neglect, but because their parents lack stable housing. In other situations, women who have fled to domestic violence shelters have trouble moving on because they can’t afford an apartment, according to Josh Balloch, vice president of government affairs and public policy for AllCare. “It’s difficult for them to take the next step because they can’t afford the first and last month’s rent and the deposit,” he said. Oregonians can take advantage of earned income tax credits and paid sick leave, which are recommended in the report, but they don’t have paid family leave. Some Democrats in the Oregon Legislature are backing 12 weeks of paid leave that would be funded by a payroll tax on workers and employers. The report says paid family leave can encourage breastfeeding, increase employee retention, keep more mothers in the workforce and reduce reliance on public assistance. The report says initiatives that ban job application questions about criminal history could help people re-enter the workforce, contribute to the economy and commit fewer crimes in the future. In 2015, Oregon passed legislation that made it illegal for employers to ask applicants about their criminal history on a job application. Employers have to wait until the job interview to ask about a person’s criminal background. Employers who are required by law to conduct background checks are exempt from the new requirements. Reach Mail Tribune reporter Vickie Aldous at 541-776-4486 or [email protected] . Follow her at www.twitter.com/VickieAldous .