In the last week, we saw the official start of the debate on health reform legislation, after months of speculation on its form. Two pieces of legislation have been released- albeit incomplete, from the Senate's Health, Education, Labor and Pensions Committee, and the trio of Committees with jurisdiction on the House side. The Senate Finance Committee has delayed the release of its bill until after the July 4 recess; until then we have an outline. (Here's a chart to help tell the differences).
Conversation continues on how these three bills will converge into one, and form a health policy document that creates real system change. However, no matter the enrollment strategies or financing mechanism used, health reform, even at its best, will not produce a healthier population. Even after ten or 15 years with an improved health care infrastructure in the United States, we are not guaranteed to see dramatic shifts in our health outcomes. What gives?
We are unlikely to see greatly improved outcomes because health is determined by a variety of factors - and medical care is only a small determinant. Actually, good health is based on a variety of factors including income, education, environmental and social conditions, genetics, and lifestyle choices (Grossman 1972; Pappas 1993; Marra and Boland 1995, and many others).
In recent years, a lot of attention has been paid to the social determinants of health (SDOH): education, crime rates, the availability of parks and grocery stores are just a few. The figure below demonstrates how SDOH act as "roots" to cultivate the health of a community by providing pathways to either fragmented systems and restricted power or a sense of community and strong social networks towards health outcomes. The assets determine the pathways and the health outcomes. (more...)
