The health of the nation depends on more than ensuring health insurance coverage for all. According to U.S. Centers for Disease Control and Prevention estimates, only about 10 percent of premature mortality in America can be traced to inadequate health care coverage. Treatment matters once a disease surfaces. But in order to prevent disease, we must focus on its upstream drivers.
Prevention means more than advising people to exercise, eat a healthy diet, and stop smoking. As research has shown, an individual’s very ability to follow health experts’ advice depends on a multitude of factors, not least of all the quality of their education, the safety of their neighborhoods, and the availability of secure jobs. When these basic elements are missing, most people have little incentive to care today about their health in the decades ahead.
That’s why any discussion of our nation’s future health policy must not stop at insuring more families. It must embrace the broader determinants of health: high-quality education for all children, affordable housing, and safe, supportive working environments.
One study among hundreds proves this point: the WellWorks Smoking Cessation Trial. This investigation involving factory workers showed that simply advising smokers to quit wasn’t enough. Workers questioned the value of kicking their habit, given that they were routinely exposed to benzene and other deadly carcinogens.
But when some manufacturing plants took steps to tighten their worker safety standards and educate workers about chemical and physical hazards, many smokers quit. As Harvard School of Public Health Professor Glorian Sorensen reported, their quit rates were double those in plants where workers were merely advised to stop smoking. Remarkably, Sorensen’s intervention wiped out the differential in quit rates between blue-collar and white-collar employees.
Reducing disparities in health is not pie-in-the-sky. We must stop blaming individuals and instead look more closely at the starkly varying incentives people face in their day-to-day lives. Then we can take practical steps to close the shameful health gaps dividing Americans today.