Image by Victor Bonomi via flickr.
We know that about 45 percent of American kids are growing up in families that are poor or near poor, and that this degree of social inequality helps explain why the health status of Americans is failing to keep up with progress in other wealthy nations.
But how to make things better is not so clear, I insisted in a recent post. I may have spoken too soon. There is now solid evidence from a long-running study in North Carolina that early childhood programs can produce health benefits that persist into adulthood. Continue reading
Health care is but one element of what makes the biggest difference in health outcomes – social factors play a far more significant role. Income and its distribution, education, employment, social supports, housing, nutrition, and the wider environment – what we have come to know as the social determinants of health – are the most powerful predictors of wellness and longevity. This has been understood for centuries, and empirically validated in recent decades with study after study demonstrating significant inequalities in health outcomes between wealthy and disadvantaged populations.
Why is it that, when we talk about health promotion, we still get stuck talking about the “Trinity Trap” of smoking, diet and exercise when we know that social factors have the biggest influence on health outcomes?
In this new tip sheet, family doctor and medical professor Ryan Meili discusses the importance of fully understanding the social determinants of health.
Image by Jay Reimer via flickr.
Medical study authors routinely claim to have “controlled” for socioeconomic status.
That kind of sweeping assertion should set off alarm bells. The authors probably haven’t come close to fully accounting for something as difficult to measure as a person’s place in the hierarchy of self-determination and power, neighborhood quality, working conditions, job security, income and wealth.
To assume otherwise is a mistake that can lead to misleading conclusions.
Consider, for example, a recent study in the journal Nature Medicine describing a genetic variation that might account for lower heart disease survival among African Americans. News coverage of the study caught my attention because whatever role genetics plays in the black/white disparity in heart disease, it’s probably small.
Some researchers have concluded that socioeconomic disadvantage is the most significant root of the problem, not genetic differences. And there is pretty good evidence that the traditional risk factors (diabetes, high blood pressure, lack of physical activity, obesity, smoking) account for all of the difference in heart disease mortality between black and white men in the United States, and most of the difference between black and white women. Continue reading
Attend AHCJ’s free Rural Health Journalism Workshop for a better understanding of what’s happening – or will be happening – in rural regions, and return to work with dozens of story ideas you can pursue.
Compared with city dwellers, people in rural America have higher rates of cancer, diabetes, disabling injuries, and other life-shortening health problems.
Among the less talked about aspects of the Affordable Care Act are measures intended to help reduce rural health disparities. But health professionals working in remote small towns aren’t convinced that the well-intentioned steps will bring enough relief – and do it quickly enough – to reverse problems that many fear are getting worse, such as lack of economic opportunity for rural residents, and limited access to high-quality medical clinics and hospitals.
“There’s definitely joys, but right now the change is huge. It’s going to make it hard for many of us to survive,” said Dean Bartholomew, M.D., a family medicine physician in Saratoga, Wyo., a town with 1,700 residents that is nearly an hour’s drive away from the nearest hospital. Bartholomew was among the panelists at the Health Journalism 2014 session on rural health.
Rural health difference
For Bartholomew, the joys include the rich relationships he’s been able to build with patients and the community. He’s found himself serving as the volunteer team physician for the local high school, for instance, and taking care of sick pets on occasion. Continue reading
“You as a society have made a decision that child poverty is what you want. I can only assume that’s the case. Otherwise you would do what European countries are doing and use taxes and transfers to reduce child poverty.” – Michael Marmot
Sir Michael Marmot isn’t the first to call out the United States for its exceptionally high rate of child poverty. About 45 percent of American kids are growing up in families that are poor or near poor (below 199 percent of the federal poverty level), up from 40 percent in 2006, according to a recent analysis.
This degree of social inequality helps explain why the health status of Americans is failing to keep up with progress in other wealthy nations. But how to make things better is not so clear. Two remarkable studies in the Journal of the American Medical Association this month highlight some of the paradoxes and hidden pitfalls inherent in efforts to boost the socioeconomic status of poor kids. Continue reading
“The idea of the wellness trust is to create a pool of money that can effectively address the social determinants that are making our families sick and the vast disparities in health and access based on which ZIP code you live in,” Jim Mangia, CEO of a network of 10 community clinics in south Los Angeles, told journalist Rob Waters.
I’d never heard of a “wellness trust” until I stumbled upon Mangia’s engaging Q&A with Waters, who blogs about health and science over at Forbes. Mangia is part of a coalition of labor and community groups trying to establish a wellness trust with funding obtained via a state law that mandates that a certain percentage of profit made by hospitals be spent on community benefits. Here’s Mangia:
“If you look at where the money is in healthcare, it’s with hospitals, health plans and insurance companies. So if you’re going to reorder the priorities of a healthcare system in a particular area, you have to use the resources of the system’s wealthiest elements. The issue is: Are these community benefit dollars actually being used for community benefits? I think some are and some aren’t. We’ve done research and know that cities and counties have some power to decide how those community benefits are spent. It’s through that process we think we can create this trust.”
Image by kardboard604 via flickr.
It seems pretty far-fetched that bringing a supermarket to a disadvantaged neighborhood could, in a matter of months, turn back the tide of obesity.
So I wasn’t exactly shocked by the study in Health Affairs (AHCJ members have free access) this week finding that the addition of a supermarket made little impact on nearby residents’ diet or weight gain. The authors compared two demographically similar Philadelphia neighborhoods. Both were considered food deserts, but one received a new 41,000-square-foot-supermarket in 2009. Six months later, the authors found no significant difference in body mass index or daily fruit and vegetable intake between residents of the two neighborhoods. (In the neighborhood with the new supermarket, most residents didn’t even adopt it as their main store.)
The link between food deserts and obesity has always been somewhat tenuous. For instance, having a nearby supermarket or grocery made no difference in the amount of fruits and vegetables people ate or the overall quality of their diets in one of the largest observational studies to date. More recently, researchers analyzed data from 97,678 adults in the California Health Interview Survey and found “no strong evidence that food outlets near homes are associated with dietary intake or BMI.” They figured it’s because most people go by car and don’t limit their shopping to nearby stores.
News outlets tended to cast the latest study as a policy fail for the Obama administration. Obama’s $400 million Healthy Food Financing Initiative is based on the idea that making fresh fruits and vegetables more accessible in underserved neighborhoods will help reverse diet-related health problems.
I’m not sure that a six-month pilot study on a single store is the final word. In a thorough report by Sarah Corapi at The News Hour, study author Steven Cummins says he remains convinced that better food stores are needed in many disadvantaged neighborhoods: Continue reading
It’s great that the rapid rise in youth obesity since the 1980s has started to level off. But there’s an unsettling trend hidden in the data: Progress has largely been limited to kids from more educated and higher income families, according to a recent analysis that got less news coverage than it should have.
Robert Putnam and colleagues at the Harvard Kennedy School compared outcomes by education and income using data from two nationally representative health surveys (the 1988–2010 National Health and Nutrition Examination Surveys and the 2003–2011 National Survey of Children’s Health).
Among teenage children of parents with a college degree, they found that the prevalence of obesity began to drop about 10 years ago, while it continued to climb among the teenagers of parents who have at most a high school degree. They found the same trend when they used estimates of family income, rather than education, to measure socioeconomic status. (The growing gap is not merely a reﬂection of racial or ethnic differences, they say, because it persisted even when they limited the analysis to non-Hispanic whites.)
Los Angeles Times reporter Melissa Healy raised an important point in her coverage: Continue reading
The idea that chronic stress can change how your body and brain work fascinated Dan Gorenstein, a radio reporter at Marketplace, and it sparked the idea for an affecting, memorable piece about poverty and health.
The report pivots on the story of a woman with a troubled past and a painful confession. How did Gorenstein find her, and persuade her to go public? How did he balance her interests with his potentially conflicting interest in pursuing a good story?
The piece also distills a lot of complicated research about chronic stress, decision making and health. But it remains a tight, fast-moving narrative. I talked to Gorenstein and got the inside story on how he did the reporting.
“For many patients, a prescription for housing or food is the most powerful one that a physician could write, with health effects far exceeding those of most medications.”
– from Housing as Health Care — New York’s Boundary-Crossing Experiment
Image by nouspique via flickr.
Housing First is a health care strategy based on the idea that secure, affordable housing is a necessary first step to care effectively for homeless people with chronic mental health and substance abuse problems. There is some evidence that this approach may, in some circumstances, even save taxpayers money (but probably not as much as is often claimed).
In a much-cited 2009 study in Seattle, researchers analyzed medical and law enforcement costs for 91 people given supportive housing and found that costs dropped to about half the level seen among 35 comparable homeless people on a waiting list.
Cities from coast to coast are ramping up efforts to provide housing as a health care solution. Reporters who keep an eye on this trend won’t be lacking for stories to pursue. There’s a lot of money at stake, for one thing. And, despite all the potential for helping people, it’s questionable whether all these projects will really save money, especially if they house more than just the heaviest repeat users of emergency rooms and jail cells. Other aspects of the Housing First model are bound to stir controversy (more on this below). Continue reading