Turret Lathe Operator

Welcome to Disparity Health, Where Health Is Everything

“Not everything is healthcare,” writes Chris Pope in an essay for the Wall Street Journal, questioning  policy advocates who focus on disparity in social determinants of health. In his commentary, he expresses doubt about diverting money from healthcare to other social programs:

“Social theories of health have become so popular because they allow states, nonprofit groups and other policy advocates to tap into the much larger pool of federal funding that is allocated to healthcare.

“Affordable quality housing is important, but it isn’t healthcare. The problem of how to increase the supply of housing in dense urban areas is unlikely to be solved by making it health insurers’ responsibility. Giving medical providers the task of solving intractable social problems burdens them with extraneous responsibilities for which they are poorly suited. It also impedes the cost-effective delivery of healthcare, which is already far too expensive.

Neglecting Social and Economic Disparities

This is quite a paradox because he has a point. Housing is not healthcare. But decades of neglecting social determinants of health has created disparities in social and economic security that are glaring. They have become so large as to put good health out of reach for many people. All the healthcare in the world cannot restore health to a person who lacks shelter, security, and access to healthy nutrition.

Social and economic stresses interact in ways that fuel the rise in chronic diseases, including obesity.

Pope seems to be out of step with the wisdom of ordinary people, though. Reporting on YouGov research, Bryn Healy explains:

“More Americans say that doctors focus too little on the social causes of health than say they focus too much on them.

“42% of Americans say that doctors aren’t focusing enough on social determinants of health as of yet. More women (47%) than men (36%) – and more Americans with a college degree (47%) than Americans without one (39%) – say that their doctors generally focus too little on the underlying social causes of health.”

Blaming Lifestyle

In one sense, we would agree with Pope that efforts to deal with social factors of health have been off target. Most often, enthusiasm for “healthy lifestyles” turns into a blame game. Efforts to nudge people toward healthier behaviors can become more coercive than helpful. The implicit bias is to presume that people are merely making bad choices.

When health systems start thinking everything is a health choice, implicit blame drives many policies. A false, unspoken presumption is that disparity is a problem of individual choices gone wrong. But the reality is that systemic failure put people in a box from which escape is exceedingly difficult.

Thoughtful policy advocates need to get curious and look to solve deeper problems.

Click here for Pope’s essay and here for Healy’s insights on public opinion about this. For more on social factors driving disparities in obesity, click here.

Turret Lathe Operator, photograph by Howard R. Hollem / Wikimedia Commons

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July 10, 2024

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