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“The lower
people’s income, the earlier they die and the sicker they live,”
said Steven Woolf, Director of the Center on Society and
Health at the Virginia Commonwealth University in testimony
before the a Senate committee earlier this month. The hearing
was called by the US Senate Committee on Health, Education,
Labor, and Pensions and its Subcommittee on Primary Health and
Aging. The hearing was entitled “Dying Young: Why Social and
Economic Status May Be A Death Sentence in America.”
Key Points
Among the key
points made by Woolf are that economic policy is not just
economic policy—it’s health policy. Second, Woolf noted that
relieving economic hardship for Americans is a smart way for
Congress to control medical spending. To illustrate his point,
Woolf reported that 25% of all deaths in Virginia would be
averted if everyone had the death rate of Virginia’s five most
affluent areas. Given that possibility said Woolf, “no form of
health care reform, and no treatments by doctors and hospitals,
can rival that kind of effect.”
In a final
takeaway message for Congress, Woolf stated “…health is affected
not only by what’s in your bank account but also, perhaps most
importantly, by policies that put people on the road to economic
success, such as helping our young people get a good education.”
The hearing was
called in part to provide evidence for not slashing spending in
future budget negotiations for education reform, job training,
urban renewal, and other safety net programs. In closing, Woolf
emphasized that “Cutting a program to save money may save
nothing if it makes people sicker and thereby drives up the
costs of health care.”
Harvard
Epidemiologist
Also testifying
at the hearing was Harvard University social epidemiologist
Lisa Berkman. She discussed life expectancy in the United
States and reported on the findings from a recent National
Academy of Science panel which found that the US ranked at the
bottom of 21 developed countries. Of even greater concern, said
Berkman, is the gap between the risk of death for those at the
bottom versus those at the top in the US. She reported on
increasing mortality gaps over the years and said “the fact that
the size of the risks varies so much suggests that such large
inequalities are not inevitable or innate, and gives hope that
there are ways to reduce the burden of illness for our most
vulnerable citizens.”
Cause of
Health
A third speaker at the hearing was the University
of Wisconsin’s David Kendig. He reminded the congressmen
that “health is
produced by many
factors including medical care and health behaviors and,
importantly, components of the social and physical environment
in which we live in like income, education, social support, and
the structure of our neighborhoods. The bottom line is that we
will not improve our poor performance unless we balance our
financial and policy investments across this whole portfolio of
factors.
How Healthy
We Could Be
Dr Kendig is one of the colleagues who helped
create the County Health Rankings (www.countyhealthranking.org)
and he discussed modeling state mortality rates and how much
they could improve.
They found that if each state had the highest level of all the
determinants that any state had already achieved, then even the
healthiest state New Hampshire could improve mortality by 24%
and the least healthy West Virginia by 46% by working on
reducing smoking rates, increasing insurance, increasing high
school and college graduation rates, increasing median family
income, and increasing employment.
Readers
interested in learning more about the testimonies and the
discussion at the hearing can view the hearing at :
http://tinyurl.com/lato73m
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