Broadening the Focus

The Need to Address the Social Determinants of Health

In its report to the Commission to Build a Healthier America, the Robert Wood Johnson Foundation showed that conditions favor a broad approach to improving health in the U.S.; socioeconomic statistics link poverty and limited education to poor health.

In 2008, at the public launch of its Commission to Build a Healthier America, the Robert Wood Johnson Foundation conferred to the Commission a report titled Overcoming Obstacles to Health. That document explained the rationale for the establishment of the Commission, outlined its conceptual framework and advanced scientific guidelines for the Commission’s work.

This paper, appearing in a supplement to the American Journal of Preventive Medicine, is an adapted version of the inaugural report presented to the Commission. The topics include: the swelling costs of health care in the U.S.; the interaction of socioeconomic and racial/ethnic health disparities; the unmet health potential residing in the nation’s disadvantaged neighborhoods; international evidence supporting social health strategies; and, the shared concern of business, the government and the general public about escalating health costs.

Key Findings:

  • Roughly 30 percent of American adults who live below the federal poverty level (FPL) report being in poor or only fair health.
  • The wealthiest men and women in the U.S. would live roughly 10 fewer years if they fell under the FPL.
  • It is unlikely that health disparities between White and Black Americans are attributable to genetic or cultural differences.

If current trends continue, by 2019 the cost of health care in the U.S. will be 19 percent of GDP. The economic picture calls for immediate societal action to reduce health care costs. All Americans have an interest in addressing social circumstances that contribute to the poor health of many of the nation’s citizens.

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