Determined Action Needed on Social Determinants

By David U. Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H.
Annals of Internal Medicine, April 17, 2018

In 2015 and again in 2016, Americans’ life expectancy decreased, the first multiyear decline since 1962 and 1963. Even before this recent dip, U.S. life expectancy lagged behind that of most other wealthy nations. Meanwhile, as health policy leaders shift payment from “volume” to “value,” they have pointed to an upswing in virtually every quality metric they reward. In addition, journals announce a steady stream of life-prolonging technical advances.

If medical care is improving, why are patients doing worse?

Deteriorating social determinants of health—the key drivers of health status spotlighted in the American College of Physicians (ACP) position paper—probably underlie this paradox. For lower-income Americans, we have stalled, or even moved backward, on combating the root causes of morbidity and mortality.