Although housing, education and infrastructure are influenced by disparate policies and government departments, each of them, along with lifestyle choices and behavior, wield a significant influence on people's overall health.
"They are inextricably linked with health equity," Marc H. Morial, president and CEO of the National Urban League, said of these factors at the Root Cause Coalition's First Annual National Summit on the Social Determinants of Health in Chicago. The National Urban League is a historic civil rights organization dedicated to economic empowerment to elevate the standard of living in underserved urban communities. "We may look at them differently because of policy reasons, the departments they're administered through or the degrees we have, but the truth is they are all tied together," he added.
As the link between reimbursement and patient outcomes strengthens, the need for hospital systems, as well as community health organizations, policymakers, business leaders and nonprofit administrators to work together to address social determinants of health becomes increasingly clear.
Mr. Morial, who has previously worked as a lawyer, professor, legislator, mayor and president of the U.S. Conference of Mayors, talked at the Root Cause Coalition event about four primary considerations when addressing social determinants of health.
1. The influence of social factors on health is evidenced by longer life spans. For most of human history, the average life expectancy was under 50 years. In 2014 — the latest year for which data is available from the CDC — life expectancy at birth for men was 76.4 years and 81.2 years for women. Along with advances in modern medicine and technology, the rapid growth in life expectancy is also due to various economic and social factors, including reduced poverty and subsequent improved social well-being, the introduction of indoor plumbing, electricity and heating, according to Mr. Morial.
Although humans' life spans have increased dramatically since the improvement of these social and economic factors, significant disparities persist between races and economic classes. "We hope that we can eliminate those disparities based on race, gender and class," said Mr. Morial. "We hope that what comes along with a longer life is a better quality of living, even at more seasoned years."
2. Housing has a direct influence on health. The quality, location and cost of housing are closely tied to health, according to Mr. Morial. For instance, affordable housing frees up resources for food and medical care costs. Additionally, residential stability and affordable housing can reduce stress and related health outcomes.
In contrast, adults who live in unaffordable housing — housing that accounts for 30 percent or more of household income — are more likely to describe themselves as in fair or poor health and are more likely to forego needed medical care due to cost concerns, according to Mr. Morial. Children who experience homelessness are also more likely to have been hospitalized at least one time since birth.
"If we want better health outcomes then we have to be advocates of affordable, quality housing," said Mr. Morial.
3. Level of education affects health. Higher education is tied to health outcomes in several ways, according to a report from the Agency for Healthcare Research and Quality called "Understanding the Relationship Between Education and Health." First, education itself predisposes the recipient to better health outcomes because it enables people to achieve higher earnings, which enable them to more easily afford housing and nutritious food. Less obvious are the soft skills associated with education, such as enhanced problem solving ability, personal control, personal efficacy, autonomy and self-directness. Each of these abilities affect the way one handles stress, which can lead to suppression of the immune system, and makes choices that influence health.
4. Accessible and affordable healthcare coverage is vital to mitigating health disparity. "For those who say [the ACA] is a horrible bill, I agree with you, except for one caveat," said Mr. Morial. "It's not more horrible than what was there before. If you don't like it, you have to compare the law to something else." Mr. Morial added that although he believes the ACA has numerous flaws, Americans should celebrate the progress the law has made in reducing the number of people without health insurance, as healthcare coverage is an important element of ensuring people have access to necessary medical care. The National Urban League supports the maintenance of the ACA until there is a replacement plan that is "absolutely better," he said. Mr. Morial outlined three requirements a replacement plan for the ACA should fulfill.
- It must provide healthcare coverage to at least as many people as the ACA has
- Coverage must be affordable
- Protect Medicaid expansion in states that have extended it