New England has basked in national attention ever since Massachusetts's big breakthrough - the agreement to require everyone to buy health insurance, to provide new, state-subsidized private health-care policies and to cajole non-participating employers.

Many states are considering parallel moves. Last month, Vermont legislators jumped on the bandwagon offering coverage to virtually all low-income residents not already protected by Medicaid.

Health excellence in New England ought to be a given. With its world-renowned teaching hospitals, its super-cluster of leading scientists, its national leadership in biosciences, the region has virtually unparalleled resources.

But ask yourself: Are New Englanders appreciably healthier than other Americans? Is the region exempt from the numbing costs of health care gobbling up public budgets? Has it found a way to avoid high levels of heart disease, stroke, diabetes and many cancers that can be held in check a lot better by diet and exercise than heroic after-the-fact operations and cures?

Sadly, the answers are no, no and no.

Wendy Everett, CEO of the New England Health Care Initiative, says 90 percent of all health-care dollars go to expensive hospital diagnosis, treatment and surgeries, not prevention and public health. No one is paid to talk people out of smoking, but the system feeds big dollars to the high-priced super-docs and labs called on to address lung cancer with chemotherapy and radiation.

Shortages of primary-care physicians, the family docs who know a patient's full history and needs, are mounting, even as big dollars flow to specialists who provide the most expensive procedures.

And to what end? Respected studies by Dartmouth Medical School professors Jack Wennberg and Elliott Fisher show that the more expensive and extensive care often turns out to be worse care.

There are some rays of light.

Pressure is mounting to reduce errors and costs by computerizing all individual medical records and, while keeping them private, making them portable (place to place and among doctors, clinics and hospitals). Support is also growing for information technology to track the tests and treatments that actually perform best - called "evidence-based medicine."

Rhode Island's Quality Institute is a leader on this front. There's a Massachusetts eHealth Collaborative, funded with $50 million from Blue Cross/Blue Shield of Massachusetts, focused on creating a broad-based health electronics record system. With Boston Foundation support, the Health Care Initiative is creating a report card to help identify new strategies to improve the region's health while strengthening its health-care economy. Even bolder strikes may be required.

Consider the actions of Arkansas Gov. Mike Huckabee, who shed 110 pounds after being told he had type II diabetes and would probably be dead in a decade. Huckabee launched a campaign for a healthier Arkansas, including school tests to inform parents of their children's body mass, a reduction of sugar-laden drinks in schools and food stamps that have more value when they're used to buy fruits and vegetables.

While each New England state may have some elements of an Arkansas-like plan in place, couldn't the six states do it even better together?

Imagine a coalition of distinguished public health departments, hospitals, universities, businesses, sports leaders and media united in defining an agenda for better health. This could include demanding more rigorous exercise and nutrition standards in schools, pushing for walkable environments, crusading against smoking and substance abuse and helping low-income workers turn away from fast-food, fat-heavy, high-temptation America.

Connect the dots

There are islands of top-notch, organized "healthy community"efforts across New England. Fall River, Mass., encourages high schools to think beyond team sports and engage all students in physical activity. Vermont's Champlain Initiative is pledged to "bend"back such unhealthy trends as obesity, poor nutrition and sedentary lifestyles. The Franklin Community Health Network, in one of Maine's most depressed rural counties, has focused on smoking, especially among young mothers and families, and now claims Maine's lowest smoking rate. (next page »)