The Latest

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

Continue Reading “The Price of Social Programs”

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

Continue Reading “Debriefing on Detroit”

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

Continue Reading “From the Urban Institute: What Would it Take to Reduce Inequities in Healthy Life Expectancy?”

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

Continue Reading “When black patients see non-black doctors”

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.

Social determinants of health comes up frequently in health policy news. Here are quotes from six stories that caught my eye over the last few months.

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

Continue Reading “Do Early Childhood Programs Work?”

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.