ArticleBroadening the Focus: The Need to Address the Social Determinants of Health
Section snippets
Overview
The human impact of health is clear: Good health is essential to well-being and full participation in society, and ill health can mean suffering, disability, and loss of life. The economic impacts of health have become increasingly apparent as well. While the overall economy declined by 1.1% from 2008 to 2009, total health expenditures rose by 5.7%.2 Annual per capita medical care expenditures in the U.S. are higher than those in any other nation, and if current trends continue medical care
Social and Economic Disparities in Health
In the U.S., where education and income are the most frequently used socioeconomic measures, Americans who are poor and those who have not graduated from high school experience considerably worse health on average than more affluent or educated Americans. Health disparities across income and education groups are seen in a range of health conditions from the beginning of life to old age.25 Evidence of these disparities by education or by income is shown here for selected conditions in Figure 1,
The Importance of Broadening the Focus
Health is influenced by a wide array of biologically determined factors, including individual characteristics like age, gender, and genetic make-up. Because individuals have little or no control over these biologically determined risk factors (and, despite high hopes, the yield of gene therapy for improving population health is as yet unproven), it makes sense to focus health policies on risk factors that are potentially modifiable, including those that may interact with genetic makeup. When
Identifying Solutions
Solutions to the complex problem of health disparities will not be simple, but this is a particularly opportune time to seek them. Widespread concern—on the part of business, government, and the general public—about medical care costs has created a sense of urgency and increased attention to potential solutions beyond the realm of medical care. This is evidenced by the American Recovery and Reinvestment Act's creation of new grants for state policy and community-level prevention and wellness
Final Remarks: A Timely Moment to Act
This paper reviews evidence highlighting the powerful influences exerted on health by socioeconomic factors such as family income and education—factors that have been shown in other studies to be more important than medical care and genetic makeup in sustaining large gaps in health among Americans with different levels of socioeconomic advantage.22, 23, 163, 164 While those at the bottom of the social and economic ladder experience the greatest health consequences of social inequalities, those
References (165)
- et al.
The lasting impact of childhood health and circumstance
J Health Econ
(2005) - et al.
Individual, neighborhood, and state-level predictors of smoking among U.S. black women: a multilevel analysis
Soc Sci Med
(2006) - et al.
Why do poor people behave poorly?Variation in adult health behaviours and psychosocial characteristics by stages of the socioeconomic lifecourse
Soc Sci Med
(1997) - et al.
Closing the gap in a generation: health equity through action on the social determinants of health
Lancet
(2008) - et al.
Health inequalities among British civil servants: the Whitehall II study
Lancet
(1991) Race, class, and environmental health: a review and systematization of the literature
Environ Res
(1995)- et al.
Contribution of job control and other risk factors to social variations in coronary heart disease incidence
Lancet
(1997) - et al.
Citizen-centered health promotion: building collaborations to facilitate healthy living
Am J Prev Med
(2011) - et al.
Social environment and physical activity: a review of concepts and evidence
Soc Sci Med
(2006) The neurobiology of stress: from serendipity to clinical relevance
Brain Res
(2000)