Sixty percent of our health is determined by social and environmental factors related to where we live, work and play. So why do we treat health like it's the responsibility of health care alone?
It's now well-known that we spend more money per capita on health care in the United States than every other industrialized country, but we aren't any healthier when we consider standard markers of public health like infant and maternal mortality or life expectancy. Research published in The American Health Care Paradox suggested a new explanation: We are getting outspent on social supports. Other countries who invest more money in housing subsidies, food assistance programs, employment programs and other social services have higher birth weights, lower infant mortality rates, and longer life expectancies. It therefore stands to reason that if we paid greater attention to healthier environments, living wages and nutrition, fewer people would suffer the considerable negative health effects of poverty.
In light of this finding, we may want to quit seeing health care and social supports as alternatives and instead see them as complements. Allowing health care expenditures to crowd out upstream investments in health has proven imprudent policy. Instead, we should see health and social services as sharing the goal of maximizing the health and well-being of society. The goal is large but we don't need to reinvent the wheel or build new infrastructure to make substantial gains in the near term. We only need the left hand and the right hand to work together. Bridging the divide between how health care and various social service agencies fund and approach health is the next frontier of population health.
One of the ways that we have started to do that is through medical-legal partnership -- programs where civil legal aid agencies, health care organizations and public health departments train their staffs, treat individuals and identify population level problems together. At first glance, civil legal aid agencies may seem like a strange partner for health care, but in fact they are natural allies. They are experts in the laws around housing and public benefits, and spend their resources to ensure access to housing subsidies and food benefits and to ensure that people aren't unlawfully denied health insurance or employment. It's not a sector that has traditionally organized its work around the principle of health, even though that's precisely what it addresses when it tackles the social factors impeding health. But by aligning their missions and working together in a focused, integrated way, civil legal aid, health care, and public health can detect problems earlier and innovate solutions that are not limited by the vision of their individual sectors. Medical-legal partnerships align existing social support services with health care.
We have to go further and build partnerships that align other sectors -- transportation, business, urban planning -- all behind a culture of health. Sectors need to share expertise and cultivate shared approaches and funding for the problems we face in our communities. But it all starts by acknowledging the incredible role that environment plays in health, and that health care simply can't do it alone.
The 10th annual Medical-Legal Partnership Summit is being held April 8-10, 2015 in McLean, Virginia.
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