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.