Researchers Contribute to Surgeon General’s Report on Social Determinants.
Researchers Contribute to Surgeon General’s Report on Social Determinants
Salma Abdalla and Dean Sandro Galea co-authored Community Health and Economic Prosperity, which highlights the social determinants underlying health inequity in the US and calls on the private sector to work to improve them.
School of Public Health research fellow Salma Abdalla (SPH’16) and Dean Sandro Galea are among the authors of a Surgeon General report published in January.
Community Health and Economic Prosperity: Engaging Businesses as Stewards and Stakeholders—A Report of the Surgeon General highlights the structural factors that have shaped unequal health in America and calling on the private sector to help tackle these social determinants of health.
The report sheds the light on the poor health of Americans compared to other peer countries—despite the US spending far more on healthcare—and the social, structural, economic, and political factors that have led to this poor health.
“While the report is framed appeal to the private sector on why it should invest in the social determinants, at core, this is a report that takes a thoughtful approach to the foundational forces that shape health and health disparities in the US,” says Abdalla, who is also the lead project director of the Rockefeller Foundation-Boston University 3-D Commission.
“It is encouraging that the Surgeon General’s office made the point that health is about much more than healthcare and that investing in the social determinants of health is also good for the economy,” she says. “The core message is important—and perhaps even more important that these points were made during an administration that was inimical to them.”
Abdalla and Galea co-authored the first chapter of the report, which summarizes the concept of social determinants of health, including health-harming factors such as pollution and racism. The chapter explains that, although the US spends more than twice as much as peer countries on healthcare, it also has the worst health, declining life expectancy, and huge gaps in health between populations. While this may seem paradoxical, the authors write, it actually illustrates how much of health is created not by healthcare, but by conditions that prevent the need for care. The US has been investing less and less in prevention, with the share of federal spending on social and economic investments having decreased by 59 percent from 1962 to 2017.
The chapter then makes the argument that, in the complex web of factors that create or prevent well-being, working to fix these problems is also good for the bottom line. In that same 1962-2017 period, federal spending on direct cash transfer and healthcare-related costs increased by 162 percent—in other words, the government has been spending more money to treat health issues, and less to prevent them through creating the conditions that allow people to be healthy (such as education, safe and affordable housing, violence prevention, environmental protection, and nutrition).
The private sector is not immune to the problem, the authors argue, because a less healthy community also means a less healthy current and future workforce (with costs including absenteeism, health insurance, and the ability to perform manual tasks), and consumers with less money to spend on non-medical products. A company working to improve the conditions that can make a community healthier, on the other hand, improves these factors while also building better civic relationships and reputation.
“My hope is that this report is yet another step to help us move from viewing health as an individual responsibility to viewing health as the product of many broader societal, political, and economic factors,” Abdalla says. “I also look forward to a day when we can make such an argument without the need for economic justification.”
Galea agrees: “Hopefully, this conversation will ultimately lead to acknowledging health as a human right in the US, which in turn will have many implications on the type of policies and political choices made in this country,” he says.
Read the full report here.