ANN ARBOR – Out of control spending on health care and insurance is a major cause of the current fiscal crises in the United States. Although the country spends far more on health than any other nation, it now ranks below all comparably developed nations — and even some developing ones — on major indicators of population health, such as infant mortality and life expectancy.
This, says 2013 Henry Russel Lecturer James S. House, is “America’s paradoxical crisis of health care and health” — spending more and more on health, but getting less and less in terms of positive health outcomes. In his Henry Russel lecture Thursday, House will address two concerns: why Obamacare and other proposals to reform health care will do little to reduce health spending or improve health, and how what has been learned about the impact of social disparities on health can actually improve health and lower spending.
The Russel lectureship is one of the university’s highest honors for its senior faculty, and House’s selection is no surprise, given his profound impact on the nation’s public health discourse. House is the Angus Campbell Distinguished University Professor of Survey Research, Public Policy and Sociology; research professor in the Survey Research Center of the Institute for Social Research; professor of sociology, LSA; professor of public policy, Gerald R. Ford School of Public Policy; and research scientist in epidemiology, School of Public Health. He has been elected to membership in the American Academy of Arts and Sciences, the Institute of Medicine, and the National Academy of Sciences.
House received his Ph.D. in social psychology from U-M in 1972, and he returned in 1978 as an associate research scientist and associate professor of sociology. During the 1970s and 1980s, he conducted groundbreaking studies showing that social and psychological factors, most notably social relationships and supports, could have as profound an impact on health as established health risk factors such as smoking and obesity. And over the last quarter century, House and others have shown that social disparities by race/ethnicity, gender, and socioeconomic position have even more profound effects on health.
But establishing that these disparities shape the experience of and exposure to virtually all major biomedical, psychosocial and environmental risk factors for health has been an uphill battle. The clinical medical community has gradually come around, House says, in part because clinicians daily see patients whose illnesses might have been prevented through earlier non-medical interventions, such as better education, income, and conditions of life and work.
But it’s been harder to reach other parts of the scientific community and those with the ability to change the system. “People who have the most influential positions in the policy making process in Washington and elsewhere are about as skeptical of the importance of social determinants and disparities as real causes of health differences in the population as the biomedical establishment was 50 years ago,” House says.
In 2008, House and several colleagues published “Making Americans Healthier: Social and Economic Policy as Health Policy.” The book tackles six critical areas that policy makers often overlook in public health calculations: civil rights, education, income support, employment, welfare, and neighborhood and housing. In an upcoming book, House will more explicitly show that these and other putatively “non-health” policies should be as central to health policy as health care and insurance are now.
These are also issues he’ll take up in his Henry Russel Lecture. No one can deny, House says, that the United States is doing something very wrong. “We’re now at the very bottom of all of the developed countries in terms of almost any indicator you can look at on population health, despite spending increasingly more on health than any other nation, and now more than we can sustainably afford.”
The trick for public policy is to change the social determinants and disparities at the base of these bad health outcomes, he says. Only this can substantially and reliably reduce the need and demand for health care, and the increasingly unsustainable spending on it as individuals, organizations, and a total society.
— By Susan Rosegrant