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Social determinants of health — health care isn't just bugs and bacteria

Dr. Jonathan Fielding, distinguished professor of health policy and management at the UCLA Fielding School of Public Health, co-authored an opinion piece published in The Hill about a new bill that would make grants available to states and communities to help people with housing, employment, and other non-medical factors that affect their health.

Wednesday, September 4, 2019

Everyone understands how the flu, diabetes and heart disease drastically impact our health, but social determinants like income inequality, poor public transportation and housing instability can have an even greater effect on well-being. For example, life expectancy increases with income. More than one-fifth of the people living in households earning less than $35,000 annually say their health is fair or poor, which is four times greater than what is reported by people living in households earning $100,000 or more. Poorly planned public transportation increases pollution, sedentary living and miles driven, which collectively can contribute to cancer, congenital anomalies, heart disease and stroke. Poor quality housing exposes its occupants to mites and other pest infestations and damp, moldy conditions lead to asthma and other respiratory illness. 

These are just a few of the community-level factors that not only increase medical costs but also lessen children’s school performance and achievement and limit our economic productivity by increasing absenteeism and decreasing presentism at work. Yet, despite the tremendous, lifelong impact of our community conditions on our health, we focus most of our energy and resources on treating the outcomes of these problems but lack the essential urgency for attacking the root causes of poor health.

The Social Determinants Accelerator Act is a good first step focusing on low-income Americans and the specific social needs affecting their health. But our nation’s problems of excessive medical care costs coupled with worsening life expectancy can only be solved when we address the impacts of larger, systemic problems, like multi-generational poverty, institutional racism and historic trauma.  

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