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A recent article by Catherine Ettman, PhD, an esteemed Assistant Professor in Health Policy and Management, published in the JAMA Forum, explores the growing body of evidence that underscores the substantial impact of economic and social conditions on both population and individual health. These conditions, collectively known as social determinants of health (SDOH), include a range of factors such as place of residence, employment, and education. The recognition of these determinants highlights the potential of policy interventions targeting SDOH to substantially improve health outcomes. However, designing effective policy solutions that address these determinants and gain acceptance from non-health policymakers presents a significant challenge.
The Assets Framework: A Guide to Policy Thinking
One effective approach to inform policy development is the use of an assets framework. This framework identifies three primary types of assets that shape population health:
- Financial Assets
- Physical Assets
- Social Assets
By understanding how these assets influence health, policymakers can devise specific non-health interventions aimed at improving health outcomes.
Financial Assets: Wealth and Health
Definition and Importance
Financial assets encompass income, savings, credit, and insurance. Wealth, more than income alone, is a critical indicator of economic well-being and a strong predictor of health. Research demonstrates that lower debt levels and higher credit scores are associated with better health outcomes. Notably, financial disparities are more pronounced in terms of wealth than income, with the wealth gap between racial and ethnic groups being particularly significant. For example, while the income gap between white and Black families is approximately 2 to 1, the wealth gap is about 6 to 1.
Policy Implications
Addressing the impact of financial assets on health suggests several non-medical interventions:
- Wealth Accumulation Strategies: Policies such as baby bonds—savings accounts for newborns redeemable upon reaching adulthood—could help low-wealth groups build financial assets, potentially leading to improved health outcomes.
- Cash Transfers and Insurance Benefits: Initiatives designed to enhance wealth through cash transfers and improved insurance benefits could also positively influence health.
Physical Assets: Material Possessions and Health
Definition and Importance
Physical assets include material possessions that provide essential benefits such as shelter (homes), mobility (cars), and communication (technology). Homeownership, for instance, offers stable housing, improved living standards, and psychological benefits, all of which contribute to better health. Conversely, financial strain from mortgage payments can negatively impact health. Additionally, homeownership allows individuals to accumulate capital that can be leveraged for health benefits.
Technology and Connectivity
Access to technology and the internet enhances social interactions and economic opportunities, further benefiting health. For example, the U.K.’s Right to Buy program, which subsidized home purchases, led to improved health indicators. Similarly, expanding high-speed internet access in the U.S. could enhance connectivity to health services.
Social Assets: Education, Status, and Health
Definition and Importance
Social assets encompass attributes that influence an individual’s role and status in society, which directly impact health. These include education, marital status, and religious affiliation:
- Education: Higher educational attainment promotes positive health behaviors such as regular exercise and healthy eating.
- Marriage: Marriage is associated with reduced alcohol consumption and longer lifespans.
- Social Support: Support from religious affiliations and marriage contributes to better health outcomes.
Disparities and Policy Solutions
Disparities in social assets contribute significantly to health inequalities. For example, minority groups in the U.S. often have lower educational attainment and poorer health outcomes. Policies aimed at:
- Affordable Quality Education: Promoting access to high-quality education can improve health across the lifespan.
- Legalizing Same-Sex Marriage: Legalization has allowed LGBTQ+ individuals to access health insurance and other benefits, enhancing their health.
Linking SDOH to Effective Policy Action
Challenges and Solutions
One of the main challenges in linking SDOH to effective policy is the abstract nature of these determinants. The assets framework can help pinpoint actionable policies that address these determinants and improve health. While traditional health policy often focuses on improving access to healthcare services, expanding the scope to include interventions that strengthen financial, physical, and social assets is crucial for a comprehensive approach to health improvement.
Conclusion
Adopting the assets framework allows policymakers to identify non-health interventions that bolster financial, physical, and social assets, ultimately leading to better health outcomes for populations. By focusing on these assets, we can craft more effective policies that not only address immediate health needs but also build a foundation for long-term health improvement.
References
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