The Social Determinants of Health

Via Ezra Klein, Gail R. Wilensky and David Satcher ask the new administration not to forget the social determinants of health. Abstract:

The Obama administration faces daunting challenges to reform healthcare. The authors,commissioners on the World Health Organization’s Commission on the Social Determinants of Health, believe that strategies to improve health by affecting the social determinants may gain bipartisan support. These determinants—including the effects of poverty, education, the treatment of women, employment opportunities, and limited access to medical care for some—areas important in promoting health, if not more so, than the direct medical determinants of health. Focusing on these determinants makes more sense than waiting until people become sick and seek care, and it often costs much less.

For fairly obvious reasons, debates about health care policy tend to be dominated by those who either make a living providing health care services (insurance companies, doctors, pharmaceutical firms, hospitals, nurses) or those whose financial interests are badly hurt by the need to pay for health insurance. This has an odd tendency to leave health a bit out of the picture even though it’s fairly uncontroversial to observe that both lifestyle issues and social issues are are more important determinants of health outcomes.

A chart:


As you can see, once genetics—about which we can’t do anything until the brave new world of Gattaca arrives—is also put in the picture, health care services start to look like a pretty small slice of the health picture. Health care services are such a large part of the economy that one can’t ignore the issue, but it is important to put the health impacts of health care in perspective.