In the 1980s through the mid-1990s there was little the health system could do to address AIDS. Today there is a lot. Would we therefore attribute no deaths to AIDS in the 1980s and early 1990s to access to health care and some of them to that factor today?
An interesting tension was raised several times at the first Drivers of Health meeting in Princeton. (You can watch the webcast of the meeting here.) On the one hand, there’s a temptation — even a policy need — to separate social determinants and health care.
Education is related to health. Better educated people tend to be healthier. Why? The pathways from education to health are varied and complex, as explained by Paula Braveman, one of the speakers at our Princeton meeting.
Much of what I’ve learned about the effect of health care on longevity comes from the work of David Cutler. He’s one of our speakers at the Princeton meeting. This post a preview of some of what he might say.
Here’s a puzzle: To what would you attribute deaths from AIDS today? Genetics? Behavior? Social or environmental factors? The health system (or its failure)? Something else? Once you have your answer, how would you know it was right? How would you test it? What evidence would you need? What studies would you do?
For centuries privileged classes have placed people into racial categories and acted upon them in ways that reflect and cement power. Racial discrimination has been woven into the fabric of many, if not all, U.S. institutions. The health system is not immune.
How much value do we obtain per dollar spent on the health system? How has that changed over time? How does it compare across countries? These are tough but important questions.
The risks to health faced by Americans long ago are different from those we face today. Some of the things that once killed many people (like poor sanitation) now kill many fewer. On the other hand, we now face new risks (like death from auto accidents) that didn’t exist a century ago.
The causal pathways from social determinants of health to health outcomes can be numerous and complex. Though some factors (like smoking) are directly related to health, others (like education or income) relate to health in a variety of indirect ways.
The U.S. is the biggest spender on health care in the world, yet national health outcomes do not reflect this massive investment. This fact forces us to question the value of health care spending: are our health care dollars worth it?