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.
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.
The community of scholars (including some of us on this project) and the health care industry have been using “social determinants of health” to mean so many things that it has lost its original meaning. Sometimes precise definitions don’t matter too much if everyone knows what is meant from context. But I don’t think that’s
Considering how much money we spend on health care in the U.S., we might hope that we allocate a good chunk of it toward evaluating the impact of the health policies we have in place. Unfortunately, this is rarely the case.
In other blog posts, we’ve discussed U.S. health care spending and outcomes. In short, we spend a lot more on medical care than other high-income countries, yet our health outcomes are often worse. We also spend a lot of money on social programs, which have been shown to be associated with improved health outcomes. It
Social determinants of health comes up from time to time in health policy news or as the subject of reports from health policy-focused organizations. Here are quotes from four stories or reports that caught my eye recently.
The Drivers of Health meeting in Detroit on September 11 focused on the research and research gaps in the connection between health and housing (presented by Roshanak Mehdipanah of the University of Michigan) and education (presented by Adriana Lleras-Muney of UCLA). The meeting wrapped up with a panel discussion including those two scholars and Robert
In one of his recent Health Care Triage videos, Aaron Carroll calls attention to a recent study published in the Journal of the American Heart Association that supposedly tells us something new about plant-based diets and health.
As I read more of the social determinants of health-related literature, I’m noticing a frequent theme: we don’t have enough information to guide decision making.
The Urban Institute recently published a report titled “What Would it Take to Reduce Inequities in Healthy Life Expectancy?” Its purpose is to articulate strategies to boost the effectiveness of the health system in addressing health-related social needs to narrow health inequities and areas of research that would help it do so. But it also
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.
One of the goals of Drivers of Health project is to engage diverse audiences in learning about what affects our health. But how do you get people interested? We thought an interactive might help, so we made one.
African American men live about 4.6 fewer years than non-Hispanic white men. There are many causes contributing to the difference, including a learned mistrust of the health system by African Americans. Another set of potential factors arises when non-black physicians treat black men. According to a study published earlier this year, that care just isn’t
Factors that affect health are often described as either “proximal” (downstream or directly affecting health) or “distal” (upstream or indirectly affecting health). For example, income is thought of as distal (upstream) because it doesn’t directly affect health.
In the United States, African American men have the worst health outcomes of any major demographic group. At age 45, their life expectancy is more than three years less than that of non-Hispanic Caucasian men and more than five years less than African American women.
While there is widespread understanding that the health system and other factors — social determinants — affect health, we know relatively little about their precise contributions to health differences across a population at a point in time or differences in health of a fixed population over time.
A common way to assess how much various factors contribute to health is to estimate how much variation in health across the country is explained by each of those factors. But explaining variation is not as useful as many may think.
I wrote about Nancy Krieger’s insightful American Journal of Public Health paper in a previous post. In this second of three posts, I will continue to unpack some of the content of her article, focusing on the distinction between correlation and causation.
In 2017, Nancy Krieger, Professor of Social Epidemiology at the Harvard T.H. Chan School of Public Health, published a truly insightful paper in the American Journal of Public Health in which she raised several conceptual problems with allocating health outcomes to contributions from risk factors.
The next public meeting of the Drivers of Health project will be held in Detroit on September 11. Housing, education, and access and quality of health care will be the focus. Why? This post explains.
In late June, Public Agenda published a report on perspectives of low-income parents on pediatric screening for social determinants of health. A key conclusion suggests a substantial challenge.
There’s a lot of evidence that social determinants of health are especially important in the early years of life. Experiences, resources, and opportunities available during childhood can influence health in ways that persist through adulthood. For these reasons, it’s especially important to evaluate the effectiveness of Early Childhood Programs, those interventions targeted at children, usually
Housing significantly affects health. In our homes, we experience the intersection of many health-related factors, and when we spend so much time in this environment, the cumulative effects of where we live can have long-term health consequences.
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.
For low-income renters and residents in the U.S., access to affordable housing has strong ties to health care spending. People faced with high rent and housing costs often forego preventive care in an effort to lessen their already significant financial burdens.
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.
Health Services Research (HSR) and the Robert Wood Johnson Foundation (RWJF) are partnering to publish a 2020 Theme Issue on Drivers of Health, to be co-edited by me and David Nerenz, PhD.
This is a guest post by Lynn Todman, PhD, the executive director for population health at Spectrum Health Lakeland in St. Joseph, Michigan, where she also serves on the City Commission. She is a Robert Wood Johnson Foundation Culture of Health Leadership Fellow.
Education is strongly associated with health outcomes, but the pathways between them are less clear. Though there’s a lot we don’t know about the relationship, careful study has teased out some explanations.
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.
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?
What drives health? This is the big and challenging question my team and I are facing on a new, one – year project funded by the Robert Wood Johnson Foundation. This website is devoted to this question, and we invite you to engage with us as we explore it.
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
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.
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.
Education
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/Wealth
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 studiessuggest that income and resources have profound effects in early life and development, but a much smaller effect on adults.
Government/Policy
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 showthat 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.
Access & Quality of Healthcare
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
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 Circumstances
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.
