Vital Directions for Health & Health Care An Initiative of the National Academy of Medicine (2017) / Chapter Skim
Currently Skimming:
3. Addressing Social Determinants of Health and Health Disparities
3. Addressing Social Determinants of Health and Health Disparities
Pages 71-96
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 71... ...
. The best available evidence suggests that a health policy framework addressing social and behavioral determinants of health would achieve better population health, less inequality, and lower costs than our current policies.
|
From page 72... ...
. Those three lines of evidence -- the relatively poor health status of the US population compared with other countries, the existence of health disparities, and fluctuations in health and health inequalities in relation to policy-driven changes in social conditions -- point to the importance of policies that address social determinants.
|
From page 73... ...
• Improving access to, effects of, and the value of clinical health care services. Differential access to high-quality health care services can create health disparities.
|
From page 74... ...
Because disadvantaged and vulnerable people should benefit most from these policies, their enactment and implementation should also reduce health disparities. Health Disparities and the Upstream Social Determinants of Health Policies that improve the overall social and economic well-being of individuals and families will reverberate across a variety range of health outcomes and help to achieve health equity.
|
From page 75... ...
States with higher benefit rates also enjoy better health returns, and this suggests that greater health could be achieved by increasing the federal benefits to match the more generous states. EITC benefits are quite low for childless workers, including noncustodial parents.
|
From page 76... ...
Beyond supporting home visiting during pregnancy and early childhood noted above, several types of policies may buffer job loss and address other temporary periods of family need: • expanding the Family Medical Leave Act to cover smaller employers, and add paid leave; • allowing family caregivers to be financially compensated for critical care, and reduce the long-term labor-market effect of family caregiving; • giving employers incentives to provide paid parental leave and paid sick leave, including for low-wage workers; and • expanding unemployment insurance, especially for low-wage workers. Most countries support time spent in caring for family members, and the availability of sick leave and parental leave is associated with better health.
|
From page 77... ...
. The Family and Medical Leave Act of 1993 provided up to 12 weeks of unpaid leave a year to care for new children or seriously ill family members or, for a subset of employees, to recover from their own health conditions.
|
From page 78... ...
, but health care services in the juvenile justice system are inadequate and lack enough mental health and substance-abuse treatment professionals (Braverman and Murray, 2011)
|
From page 79... ...
. The best available evidence indicates that high-quality early education programs have both social and health benefits (Campbell et al., 2014; Community Preventive Services Task Force, 2015; Duncan and Magnuson, 2013)
|
From page 80... ...
Healthy behavior incentives. Health behaviors account for over one-third of premature deaths and are strongly influenced by socioeconomic factors (McGinnis et.
|
From page 81... ...
Injuries from firearms are an important and preventable source of health disparities, especially for youth and young adults, for whom gun incidents are the second leading cause of death. Homicides are visible and garner attention, but firearm suicides are nearly twice as common as firearm homicides -- 21,175 versus 11,208 in 2013 (Xu et al., 2016)
|
From page 82... ...
The ACA provides opportunities to link efforts in the clinic with those in the community. As part of moving from a volume-based health system to a value-based health system, current demonstration projects funded by the Department of Health and Human Services are examining whether and how integration of public health activities with clinical care systems can improve population health, enhance quality, and lower costs.
|
From page 83... ...
Bundled payment models generally provide bonus payments for higher quality of care. Payment mechanisms that value prevention over acute care should encourage providers to address social factors that drive the need for services.
|
From page 84... ...
In 2014, about 33 million Americans were uninsured for at least part of the year. The ACA improved health care access substantially by establishing health insurance exchanges, although enrollment in exchanges varies by state.
|
From page 85... ...
Pressing priorities therefore include • requiring Medicare Part D and exchange health plans to cover chronic disease care that leading bodies certify is highly effective, that has only modest cost, and whose cost is a barrier to using the service; • expanding Medicare, Medicaid, and exchange health plans to cover dental care; and • expanding standards for primary care medical homes and other advanced primary care practice designs to allow adequate access to and use of preventive dental care. Conclusion The emphasis in our health system on medical treatments for acute problems has yielded benefits for some but has failed to achieve the levels of population health and longevity enjoyed by other nations.
|
From page 86... ...
American Journal of Preventive Medicine 50(3)
|
From page 87... ...
BMJ 352:h6704. Community Preventive Services Task Force.
|
From page 88... ...
American Journal of Public Health 105(2)
|
From page 89... ...
2016. Poverty and child development: A lon gitudinal study of the impact of the earned income tax credit.
|
From page 90... ...
2012. The effect of the earned income tax credit on infant health.
|
From page 91... ...
2015. The earned income tax credit.
|
From page 92... ...
American Journal of Public Health 105(8)
|
From page 93... ...
2010. Effects of prenatal poverty on infant health: State earned income tax credits and birth weight.
|
From page 94... ...
American Journal of Public Health 105(4)
|
From page 95... ...
Chan School of Public Health and Harvard Kennedy School, and is former Assistant Secretary for Health, US Department of Health and Human Services. David Satcher, MD, PhD, is Director, Satcher Health Leadership Institute, and is Poussaint-Satcher-Cosby Chair in Mental Health, Louis W
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.