On November 20th, the Health, Education, Labor, and Pensions Committee subcommittee on Primary Health and Aging held a hearing, “Dying Young, Why Your Social and Economic Status May Be a Death Sentence in America,” which explored the troubling link between poverty, decreased life expectancy, and increased rates of chronic disease. The hearing featured testimony from authors who have recently published related work in Health Affairs.
The committee heard testimony from David Kindig, Emeritus Professor of Population Health Sciences, University of Wisconsin School of Medicine, and Lisa Berkman, Director of the Harvard Center for Population and Development Studies and Thomas D. Cabot Professor of Public Policy and Epidemiology. Their testimony highlighted a chart (see Exhibit 2) from Kindig’s Health Affairs research. Also testifying was Steven Woolf, Director of the Center on Society and Health and Professor of Family Medicine and Population Health, Virginia Commonwealth University. Others who testified at the hearing included Nicholas Eberstadt of the American Enterprise Institute, Michael Reisch of the University of Maryland School of Social Work, and Sabrina Schrader, a constituent from West Virginia who provided a heartfelt and compelling personal story detailing the impacts of poverty on health.
Dr. Kindig, whose research was featured in the March 2013 issue of Health Affairs, spoke of the troubling association between poverty and poor health outcomes. He emphasized that while health insurance is “necessary for health, it is not the most important factor.” He continued by stating that “outcomes such as improved life expectancy and improved health and quality of life are shaped by socioeconomic and behavioral factors which will require resources to achieve.”
Kindig also highlighted how, as a national health care system, we spend a third more in medical care than those who do better than us, and suggested that “waste is theft,” as it deprives our health system its ability to make other kinds of investments that we know would be more health promoting. Finally, Kindig recommended that more research be done to determine the socio-economic factors which most impact health, to aid in the development of the most cost-effective investments across the entire range of health determinants.
Dr. Berkman, whose research appeared in the August 2012 issue of Health Affairs, testified that US life expectancy has lost ground in the past decade compared to other countries and shared that the US ranked at the bottom of 21 industrialized nations for life expectancy. Of paramount concern to her was the link between the widening education gap and life expectancy. In 2007, the death rate for women without a high school education was three and a half times greater than the death rate for more educated women. Like Dr. Kindig, she emphasized that “health care alone cannot prevent disease,” continuing that “to reduce disease we need to look at what causes high rates of dying among the poor and less educated.”
Later in her testimony, Dr. Berkman shared some policy prescriptions that she felt would help to reduce the link between poverty, lack of access to education, and deleterious health outcomes. She suggested that the Earned Income Tax Credit program reduced odds of maternal smoking and increased mothers’ odds of working and making higher wages. She also spoke in support of maternity leave policies, which she said lead to wage growth, increased career prospects, labor market attachments and employability.
Lastly, Berkman noted that pro-family work practices promote health. She pointed to research that in long-term care facilities, managers who were attentive to family issues had employees who were half as likely to have cardiovascular disease, less likely to be overweight, had lower blood pressure, and lower rates of diabetes. She stated that these benefits are generally not counted in cost-benefit analyses of these policies, and that failing to include these health metrics underestimated the benefits of these policies to public health.
“Socio-economic policies that are health promoting aren’t counted as health promoting. We need to change our calculations on how we account for costs and benefits,” Berkman concluded.
Dr. Woolf, published in the October 2011 issue of Health Affairs, sounded a similar theme. “Economic policy is not just economic policy; it’s health policy,” he observed. “Relieving economic hardship for Americans is a smart way for Congress to control medical spending,” said Woolf, who chaired the Institute of Medicine panel that produced the seminal report “US Health In International Perspective: Health Shorter Lives, Poorer Health.”
“Health is affected not only by what’s in your bank account, but also by policies that put people on the road to economic success, such as helping our young people get a good education,” he added.