“An ounce of prevention is worth a pound of cure”

Providing universal health care in America would be easy if it were free. Sadly, that is not the case. All too often, the general public, doctors and researchers are quick to look for new drugs, devices or technologies as a solution to maximize health and efficiency, yet research has consistently shown that health services themselves only determine a small proportion of society’s overall health. It is instead aspects like education, poverty, and safe communities that most strongly determine the health of a population.

Acknowledging the overwhelming importance of social factors inevitably leads to vastly different priorities in health spending compared to the traditional model of health care delivery.

Source: Partha S. Sahana (Flickr/CC)

Source: Partha S. Sahana (Flickr/CC)

Elizabeth Bradley of the Yale School of Public Health argued at the Academy Health National Health Policy Conference in February that social services are inextricably linked to health care. She advocated for an upstream approach to disease prevention that treats the underlying roots of disease, rather than the end complications. Social service spending, she posited, might have a greater effect on population health than health care itself.

Research findings have shown the health of a population improves when systems have a balanced approach to social services spending and direct health costs. As one might imagine, the United States is heavier on the direct medical spending side, which Bradley argues may be an underlying cause for our country’s chronic underperformance in health outcomes. To put it plainly: systems get more value per dollar when they invest in the social determinants of health.

Social determinants of health continue to be a hot topic in public health, because of the evidence of its effectiveness. When James Becker from the West Virginia Bureau for Medical Services discussed the difficulty in covering Sovaldi, a drug used to treat hepatitis C, he not only highlighted the high cost of the drug, but the fact that, “It doesn’t make sense to pay for Sovaldi if you don’t address substance abuse to prevent reinfection.” While the decision appears purely financial, clearly the true solution is linked to poverty, substance abuse, harm reduction and other difficult public health issues.

While many well versed in public health may already see value in the social determinants of health, many acknowledged that many policymakers are not easily sold on the concept. It’s an especially tough sell when compared to opposing budgetary priorities such as drug or device development.

What can public health professionals say to those attempting to convert an unenthusiastic audience? The advice was simple. Practice your pitch frequently, especially in front of skeptical, but friendly faces. Be sure to anticipate pushback and ready your responses. Finally, personalized stories can go a long way, especially those involving children. Even the greatest of cynics can’t possibly blame small children for environmentally exacerbated asthma.

 Anecdote by Kyle Fischer, MD