Category: Social Determinants of Health

Busting the seven great myths of poverty

A nice summary of many of the most common myths about the poor, then this:

The United States, the richest country in the world, spends only 6.3% of the federal budget on public assistance. Fraud in the SNAP program is a single penny on the dollar. Public assistance programs are some of the most well-run, efficient programs in government. Yet we continually hear from the right and the left that these programs are a waste of our tax dollars. Instead of worrying about that $4.45 a day our less fortunate neighbors are getting as a part of their SNAP benefits, we should be more concerned with corporate welfare in which wages have been artificially depressed due to a minimum wage that has not kept pace with inflation. If we truly want to reduce the number of people on public assistance, we must raise the minimum wage and index it to inflation.

Until that happens, let’s show a little compassion for those who are less fortunate. Believe it or not, they did not ask to be poor.

Busting the seven great myths of poverty

They have health insurance but may not understand it

 

WASHINGTON – Nine months after Americans began signing up for health insurance under the Affordable Care Act, a challenging new phase is emerging as confused enrollees clamor for help in understanding their coverage.

Nonprofits across the country are being swamped by consumers with questions. Many are low income, have never had insurance, and have little knowledge of the health-care system. The rampant confusion poses a potential hurdle for the success of the health law:

If many Americans don’t understand health insurance, that could hurt their ability to use their benefits – or to keep their coverage altogether.

A federal program to help consumers has also run out of money.

They have health insurance but may not understand it

The giant problem American health care ignores – Vox

 

Adrianna McIntyre: Can you start by summarizing the core message in your book — what is the "paradox" in American health care, and how do you start to unravel it?

Lauren Taylor: The paradox that we outline is one that a lot of readers will be familiar with: that the United States has very high health-care costs, and in many cases middling — and sometimes lousy — health outcomes when you look at certain metrics. These are metrics — like infant mortality and life expectancy — where, when you look across developed nations, we’re really at or near the bottom.

People cited this paradox before our book, and tried to explain it in any number of different ways. That included rationales like, "Well, U.S. health outcomes are bad because too few people have insurance" or "because prices are just high."

What our book tries to do is offer another reason that hasn’t been talked about much in health policy: maybe "health spending" isn’t telling us the whole story. Maybe we need to look at a broader summary of what resources nation puts in to support population health.

To do this, we included social services spending in our study, which captures things like housing, food assistance, and job training. The ratio of health to social-service spending was more predictive of several outcomes than health spending alone. This led us to suggest that social-service spending — and, more broadly, attention to the social determinants of health — could be a missing piece in the health reform discourse.

The giant problem American health care ignores – Vox

How Austerity Kills – NYTimes.com

 

If suicides were an unavoidable consequence of economic downturns, this would just be another story about the human toll of the Great Recession. But it isn’t so. Countries that slashed health and social protection budgets, like Greece, Italy and Spain, have seen starkly worse health outcomes than nations like Germany, Iceland and Sweden, which maintained their social safety nets and opted for stimulus over austerity. (Germany preaches the virtues of austerity — for others.)

As scholars of public health and political economy, we have watched aghast as politicians endlessly debate debts and deficits with little regard for the human costs of their decisions. Over the past decade, we mined huge data sets from across the globe to understand how economic shocks — from the Great Depression to the end of the Soviet Union to the Asian financial crisis to the Great Recession — affect our health. What we’ve found is that people do not inevitably get sick or die because the economy has faltered. Fiscal policy, it turns out, can be a matter of life or death.

How Austerity Kills – NYTimes.com

To Fix Health Care, Help the Poor – NYTimes.com

To Fix Health Care, Help the Poor – NYTimes.com:

IT’S common knowledge that the United States spends more than any other country on health care but still ranks in the bottom half of industrialized countries in outcomes like life expectancy and infant mortality. Why are these other countries beating us if we spend so much more? The truth is that we may not be spending more — it all depends on what you count.

In our comparative study of 30 industrialized countries, published earlier this year in the journal BMJ Quality and Safety, we broadened the scope of traditional health care industry analyses to include spending on social services, like rent subsidies, employment-training programs, unemployment benefits, old-age pensions, family support and other services that can extend and improve life.

We studied 10 years’ worth of data and found that if you counted the combined investment in health care and social services, the United States no longer spent the most money — far from it. In 2005, for example, the United States devoted only 29 percent of gross domestic product to health and social services combined, while countries like Sweden, France, the Netherlands, Belgium and Denmark dedicated 33 percent to 38 percent of their G.D.P. to the combination. We came in 10th.

What’s more, America is one of only three industrialized countries to spend the majority of its health and social services budget on health care itself. For every dollar we spend on health care, we spend an additional 90 cents on social services. In our peer countries, for every dollar spent on health care, an additional $2 is spent on social services. So not only are we spending less, we’re allocating our resources disproportionately on health care.

Our study found that countries with high health care spending relative to social spending had lower life expectancy and higher infant mortality than countries that favored social spending. While the stagnating life expectancy in the United States remains at 78 years, in many European countries it has leapt to well over 80 years, and several countries boast infant mortality rates approximately half of ours. In a national survey conducted by the Robert Wood Johnson Foundation, four out of five physicians agreed that unmet social needs led directly to worse health.

It is also well understood in the public health communities that health has far more to do with overall poverty than access to health care, per se. But we have this hard headed approach in America to “punish” the “undeserving” poor. Therefore we shoot ourselves in the foot economically in order to feel better about our “values.”
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