The Shifting Boundaries of Health Care

The following is an interview with Patrick Scott Romano, MD, MPH, FACP, FAAP, Professor of Internal Medicine and Pediatrics at UC Davis Health and C0-Editor in Chief of Health Services Research.
By Kate Raphael
Posted: December 24, 2019
The following is an interview with Patrick Scott Romano, MD, MPH, FACP, FAAP, Professor of Internal Medicine and Pediatrics at UC Davis Health and C0-Editor in Chief of Health Services Research.
By Kate Raphael
Posted: December 19, 2019
The following is an interview with Lisa Simpson, MB, BCh, MPH, FAAP, President and CEO of AcademyHealth, with input from several senior staff at AcademyHealth. Follow her on Twitter @DrSimpsonHSR
By Kate Raphael
Posted: November 26, 2019
The following is an interview with Kathy Ko Chin, MS, President and CEO of the Asian & Pacific Islander American Health Forum, a national health justice organization which influences policy, mobilizes communities, and strengthens programs and organizations to improve the health of Asian Americans, Native Hawaiians, and Pacific Islanders. She’ll be speaking as a panelist
Continue Reading “Addressing Symptoms and Root Causes”
By Kate Raphael
Posted: November 19, 2019
The following is an interview with Betsey Tilson, MD, MPH, Director and Chief Medical Officer for the North Carolina Department of Health and Human Services. She’ll be speaking as a panelist at our Cambridge meeting on December 2.
By Kate Raphael
Posted: November 7, 2019
The following is an interview with Daniel Polsky, PhD, MPP, Distinguished Professor of Health Economics at the Bloomberg School of Public Health at Johns Hopkins University.
By Kate Raphael
Posted: November 4, 2019
The following is an interview with Sandro Galea, PhD, physician, epidemiologist, author, and dean and Robert A. Knox Professor at Boston University School of Public Health.
By Austin Frakt
Posted: September 19, 2019
The following is an interview with Len M. Nichols, Ph.D., Director, Center for Health Policy Research and Ethics, Professor of Health Policy, College of Health and Human Services, George Mason University.
By Austin Frakt
Posted: July 22, 2019
The following is an interview with Paula M. Lantz, PhD, Associate Dean for Academic Affairs, James B. Hudak Professor of Health Policy, Ford School of Public Policy, University of Michigan. Dr. Lantz is also a member of the Drivers of Health project advisory committee.
By Austin Frakt
Posted: July 15, 2019
The second in a series of posts providing insights from our advisory committee members, the following is a brief interview with Heather Howard, J.D., Lecturer in Public Affairs at the Woodrow Wilson School of Public and International Affairs, Princeton University.
By Austin Frakt
Posted: July 1, 2019
The following is a brief interview with David R. Nerenz, Ph.D., Director Emeritus, Center for Health Policy and Health Services Research, Vice-Chair for Research, Department of Neurosurgery, Henry Ford Health System. Dr. Nerenz serves on the Drivers of Health advisory committee.
Health behaviors encompass a wide range of human behaviors that affect health including: physical activity; diet; sleep; and tobacco, alcohol, and other substance use. Just as one example, reducing exposure to tobacco has been identified as the single biggest way to prevent morbidity, disability, and early death.
Environmental factors — natural and built — have profound effects on our health. Of course, factors like air quality affect our health, evidenced by a study that demonstrated an association between higher levels of air pollutants O3 and PM2.5 and pediatric pneumonia. Environmental conditions even before birth (present during fetal development) can affect health and well-being into adulthood.
Genetics play a role in the development of certain disease. For example, while cancer is not caused by genetics, most cancers have some genetic determinants. The BRCA1 and BRCA2 genes play a role in tumor suppression, and, when mutated, increase the risk of female breast, ovarian, and other cancers.
Racial Identity is closely associated with health outcomes in the US. For example, African-American adults experience much higher levels of mortality than white adults, from all causes. Racial Identity also plays a role in the accumulated stress from discrimination and in the quality of health care received.
Evidence suggests that gender identity plays a role in health and health care. For example, one study found that women with angina pectoris and low socioeconomic status were referred to cardiologists less frequently than men.
Evidence suggests that education has a causal effect in reducing mortality. Among all age groups, every additional year of school is associated with increased self-reported health status.
Income and wealth are associated with health, but through complex pathways. While income and wealth facilitate access to health care, food, and housing, it’s also true that good health facilitates labor force participation, potentially leading to higher income. Several studies suggest that income and resources have profound effects in early life and development, but a much smaller effect on adults.
A wide range of government policies can affect health. For example, in 2007, Australia became the first country to introduce a government-funded human papillomavirus (HPV) vaccination program. For years later, significantly lower levels of HPV were present in the population. As another example, studies show that Medicaid expansion in the US facilitates access to care and improves self-reported health outcomes. Policies outside the health system can affect health too. Those pertaining to deportation of undocumented immigrants and same-sex marriage have been linked to health outcomes, for example.
Medical care is designed to facilitate good health, so both the quality of medical care and access to it influence our health outcomes. One study found that the medically uninsured receive 20% less care after auto accidents and have significantly higher mortality rates than people who are insured.
Occupation is linked to health outcomes, and may both cause health due to the conditions of the job, and be caused by health due to the limitations particular to certain conditions.
Social relationships can affect mental and physical health as well as behaviors and mortality risk. The people we are surrounded by (at an early age, parents, and later in life, peers and romantic partners) strongly influence health through mechanisms of stress, social support, and pressure to engage in or avoid risky behaviors.
Health behaviors encompass a wide range of human behaviors that affect health including: physical activity; diet; sleep; and tobacco, alcohol, and other substance use. Just as one example, reducing exposure to tobacco has been identified as the single biggest way to prevent morbidity, disability, and early death.
Race is closely associated with health outcomes in the US. For example, African-American adults experience much higher levels of mortality than white adults, from all causes. Race also plays a role in the accumulated stress from discrimination and in the quality of health care received.