Income, housing, institutional racism and other social and economic conditions have more impact on health than health care, according to a Center on Budget and Policy Priorities report released Thursday.
And better decisions by state and local policymakers could improve health, the report explains.
“A broad body of research has documented the effects that social determinants of health have on health outcomes, like life expectancy, maternal and child health, and rates of chronic disease, and on disparities in the health of people across racial groups and income levels,” the CBPP report said.
“But even as this understanding grows, most efforts to improve health remain focused on the health care delivery system.”
“Focusing exclusively on health care ignores the importance of a wide variety of state and local investments in promoting health.”
CBPP draws on multiple studies to illustrate how health can be determined not only by inadequate access to health care, but by racism, income and wealth inequality, and other structural factors.
And budget and policy decisions at the state and local level can do much to improve a population’s health.
State and local “policymakers play a considerable role in determining whether and where” conditions conducive to good public health exist, the report said:
For example, while individual behaviors like a nutritious diet and active lifestyle are important for health, policies shape where people can afford to live and whether those places are served by grocery stores with fresh food, public transit that reduces car-dependence, and public parks and recreation spaces that provide safe places to be active. To dramatically improve health and eliminate health inequities, states and localities must also consider how the policies they implement come together to enable, or hinder, health.
The country’s history of structural racism and income and wealth inequality “have contributed to particularly poor health outcomes for people of color.”
While much of the health care debate in the U.S. focuses on national policy, CBPP notes that states can increase access to care by broadening Medicaid eligibility, and connecting Medicaid to non-medical support such as housing or personal care service.
State-level budget decisions also have direct impacts on health, and CBPP urges state and local governments to invest in public transit, water and wastewater infrastructure, public housing and rental support programs, education, and economic supports such as tax credits for low-income earners and families.
The report also recommends states adopt non-budget policies “that also meaningfully improve population health,” specifically higher minimum wages, and paid sick and family leave.
And the report urges states to “raise revenue equitably,” by reversing their typical reliance on sales taxes, “which hit low-income families particularly hard, since they spend a greater share of their income relative to higher income families.”