Saturday, July 31, 2010

The Social Determinants of Health

I am nearly finished reading Successful Societies: How Institutions and Culture Affect Health and couldn't be happier with the state of research on the social determinants of health. While my work focuses more on health care, I am pleased to see this field progressing so quickly. Public policy which references the social determinants of health is likely years away in the U.S. (though it is beginning to gain traction in some European countries). However, I am definitely beginning to see it filter through discussions of health care policy. Most people recognize that the recent health reform law signed into law by President Obama is really more of a health insurance reform. The law creates a system where more Americans will be insured but it doesn't constrain the excesses of the insurance industry other than to prevent them from doing particularly deplorable things, like refusing to pay for cancer treatment because someone underestimated their weight when they first applied for coverage.

A recent post highlights the continuing danger the insurance industry poses as the law begins to be implemented. Not surprisingly, insurance companies are working to purchase legislators who will be favorable to their profiteering. This was one of the reasons that many people felt that any health reform should further limit the power of these insurers. In some other high-income countries you still have insurance companies through which care is rendered. Such a system can work as it has in the Netherlands and Germany. However, when these companies are singularly focused on profit and not on providing the best care for their clients, it is difficult to not wish for further regulations.

Also, the Commonwealth Fund recently released a fascinating (if not surprising) report which highlights how the U.S. health and health care system is doing in relation to other high income countries for which comparable data is available. The results are not good. The U.S. is in the bottom 2-3 (out of 7 countries) for nearly all of the measures and only on two does it make the top 4. All of this despite the U.S. having the most expensive health care system in the world. However, the authors of the report are optimistic that some of the measures in the recent health reform bill may give the U.S. better results over time.

Friday, July 9, 2010


There is a fun site called Lookshelves that has people present a photo of some part of their bookshelf and then answer five simple questions about their collection. Instead of a picture, here is a link to my Shelfari, a site that allows you to put books on a virtual shelf to keep track. My shelf on Shelfary contains about 1/3 of our current collection.

1) Who are you and where are you?
My name is Eagan and I am in Washington, D.C. (well technically Silver Spring, MD -- which is just outside the DC border, but most people have no idea where that is)

2) What do you do for work?
I am a health care analyst for an arm of Congress which provides oversight of the federal government and publicly spent funds.

3) What do you do for fun?

Spending time with Heather. This often includes hanging out at bookstores, seeing new exhibits at D.C.'s many museums and galleries, trying new restaurants, watching movies, and discussing politics.

4) Tell me something about your bookshelves.
Our bookshelves are currently the largest and cheapest that Ikea had to offer. We have four of them and they each fit around 200 books. However, they are all completely full and we have had to resort to stacking books on top of the books on the shelf. We also have one bookshelf from my Mom's old toy store.

5) Tell me something about ONE of the books on your shelf.
The most bookmarked book I own is Development as Freedom by Amartya Sen. In grad school it was my bible but I haven't gone back to it much since then. I am sure I will read it again soon and the ideas in it still influence my work greatly. It comforts me to know it is always there.