By Kate Leo
The United States spends the most on healthcare out of all high-income countries, yet we by far have the worst health outcomes. The U.S. spends an average of $9,086 per person on healthcare, and our life expectancy is 78.8 years. Meanwhile, Switzerland, the second-highest spending country, spent $6,325 per person on healthcare and has a life expectancy of 82.9 years (1). Why do we seem to invest so much and not get much out of this investment? Since beginning my public health classes at the Gillings School of Global Public Health, I have been exploring this concept, and a lot of it has to do with our lack of funding for solving social determinants of health.
Although I had some idea of what this term meant going into my classes, I had no idea the depth of the topic and how important it is for everyone to understand what social determinants of health are. In short, social determinants of health are defined as “the factors apart from medical care that can be influenced by social policies and shape health in powerful ways”(2). Factors such as living conditions, socioeconomic status, an individual’s workplace, access to food, and level of education are all examples of different social determinants of health. It is important to realize that these factors are not solely based on access to medical care or the actual clinical care itself; social determinants of health are the external factors that influence health outcomes. They can be seen as the root causes of medical issues due to inequities and disparities (2). Without addressing these root causes, it is like we are putting a bandaid on issues. When a patient goes to a doctor’s office when they are sick or have a problem, the medical issue is addressed. The social determinant of health is not considered, so the real issue is not fixed. This is a significant problem with the healthcare system because the patient will likely keep returning to the doctor’s office for the same issue. Medical supplies that could be otherwise saved and used more efficiently are then wasted.
If we focused on increasing healthy food access, education, safe housing, equal job opportunities, etcetera, positive health outcomes would rise dramatically (3). Our healthcare system is currently operating inefficiently because the policy is too focused on fixing the problem after it occurs instead of implementing preventative measures that improve social determinants of health.
References:
U.S. Spends More on Health Care Than Other High-Income Nations But Has Lower Life Expectancy, Worse Health: Commonwealth Fund. The Commonwealth Fund. https://www.commonwealthfund.org/press-release/2015/us-spends-more-health-care-other-high-income-nations-has-lower-life-expectancy. Published October 8, 2015. Accessed March 5, 2021.
Braveman P, Gottlieb L. The social determinants of health: it's time to consider the causes of the causes. Public Health Rep. 2014;129 Suppl 2(Suppl 2):19-31. doi:10.1177/00333549141291S206
Galea S. America spends the most on healthcare but isn’t the healthiest country. Fortune. https://fortune.com/2017/05/24/us-health-care-spending/. Published May 24, 2017. Accessed August 26, 2020.
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