Think 'upstream' to improve health in the United States

July 1, 2016

Photo credit: Jerry Naunheim Jr. / © CHA
Laura Carstensen


ORLANDO, Fla. — Dr. Steven Woolf, a family medicine physician and social epidemiologist trained in public health, encouraged his audience at the Catholic Health Assembly to explore how support of education, opportunities for good jobs with potential for income advancement and better neighborhood environments can lead to healthier communities and individuals.

Woolf, a professor of family medicine and population health, directs the Virginia Commonwealth University Center on Society and Health. He was study panel chair and co-author of the 2013 report "U.S. Health in International Perspective: Shorter Lives, Poorer Health." The study was conducted by the Institute of Medicine and the National Research Council.

In a keynote speech at the assembly he said that despite excessive spending on health, health outcomes in the United States have been worse than those in other wealthy nations for decades. And he added, "The notion that we are sicker than people in other developed countries is not widely understood."

Woolf said poverty and low education status correlate with poorer health and shorter lives.

He said there are many reasons for this, among them: unsafe and unhealthy housing; stores and restaurants selling unhealthy food may outnumber markets with fresh produce; neighborhood streets may be unsafe or communities may lack places to exercise, walk and cycle. Poorer neighborhoods are often closer to sources of pollution such as highways and factories and have little access to primary care doctors and hospitals.

He said that data show the higher someone's education, and the higher someone's income, the better their health at every stage of life. He cited a study led by Stanford University economist Raj Chetty and published this year in The Journal of the American Medical Association that showed the gap in life expectancy between the richest 1 percent and poorest 1 percent of individuals in the United States was more than 14 years for men and more than 10 years for women.

Addressing his fellow physicians in the audience of Catholic health executives, he said, "Getting kids to graduate high school is way more important than any prescription you'll ever write."

Woolf said the reasons why education matters to health and disease burden are complex, but, simply put, in a knowledge economy, a good education often leads to a better paying job.

More income often allows someone the opportunity to live in a safe neighborhood and send their kids to good schools. And conversely, people who live in poverty face high stressors including higher risk of being a crime victim and the economic instability that comes with poor paying jobs. "It is often said these days that zip code is more important than genetic code" in determining an individual's health, he said. "Education matters hugely if you are going to have any leverage in changing health outcomes."

Woolf praised Catholic health systems for their long-standing and collaborative efforts in their communities to address social and economic barriers to health and their work to advance principles of social justice. He quoted from Pope Francis' Apostolic Exhortation: Evangelii Gaudium. In it, the pope wrote: "Just as the commandment 'Thou shalt not kill' sets a clear limit in order to safeguard the value of human life, today, we also have to say 'thou shalt not' to an economy of exclusion and inequality. Such an economy kills."

Every step on the income ladder is correlated with better health. But, Woolf added, rich people in the United States also die sooner than rich people in other rich countries.

Woolf said countries that have greater longevity and better health status in comparison to the United States spend a great deal less on health care and a great deal more on social services than does the United States.

He spoke about the power of acting locally and the positive change being driven in select United States cities by the "collective impact movement." Collective impact is a commitment from people representing varied sectors in a community to work together on a common agenda for solving a specific social problem or problems. In places including San Diego and the Atlanta neighborhood of East Lake many sectors of the community have joined together to take responsibility for improving community health, he said.


Copyright © 2016 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Copyright © 2016 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.