Social Determinants of Health in the News
By Kate Raphael
Social determinants of health and health-related social needs are frequently featured in both popular news sources and academic publications. These excerpts from six recent stories caught our eye.
1. Flint’s Children Suffer in Class After Years of Drinking the Lead-Poisoned Water, New York Times, November 6, 2019.
The percentage of the city’s students who qualify for special education services has nearly doubled, to 28 percent, from 15 percent the year the lead crisis began, and the city’s screening center has received more than 1,300 referrals since December 2018. The results: About 70 percent of the students evaluated have required school accommodations for issues like attention deficit hyperactivity disorder, also known as A.D.H.D.; dyslexia; or mild intellectual impairment, said Katherine Burrell, the associate director of the [Neurodevelopmental Center of Excellence].
Long before Flint’s water system was contaminated, its schools exemplified the struggles of urban districts — as its tax base shrank, its student population drifted to charter schools and its core public schools were left with a small but troubled and impoverished student body….When the lead crisis began unfolding in 2014, the tiny school district had a $21 million budget deficit that required it to cut more than 200 staff members, including special education teachers.
2. Addressing Social Determinants of Health through Medicaid: Lessons from Oregon, Journal of Health Politics, Policy and Law, December 1, 2019.
States and the federal government have expressed interest in using public programs to address SDOH. A growing number of states have begun requiring [managed care organizations] to address SDOH as part of their contracts (Artiga and Hinton 2018). In addition, CMS recently announced plans to expand the range of benefits that can be covered by Medicare Advantage plans to include non medical services that improve health or health-related quality of life (CMS 2018b). Moreover, Health and Human Services Secretary Alex Azar recently suggested that CMS may grant health care organizations greater flexibility to pay for housing, nutrition, and other social needs (Azar 2018). However, additional evidence is needed about best ways to implement and fund SDOH investment, and about the impacts and returns from such investment (Gottlieb et al. 2016, 2017).
3. A Systematic Review and Meta-analysis of Depression, Anxiety, and Sleep Disorders in US Adults with Food Insecurity, Journal of General Internal Medicine, December 2019.
These large standardized meta-analyses show that [food insecurity (FIS)] is associated with an increased risk of depression, anxiety, and sleep disorders. For physicians caring for diverse or marginalized populations of patients, individuals screening positive for FIS may warrant follow-up screening for depression, anxiety, and sleep disorders. Similarly, for patients manifesting evidence of depression, anxiety, and sleep disorders, it may be appropriate to assess for the presence of FIS, especially given the link between nutrition and emotional well-being.
The evidence for the FIS–depression association is perhaps the most significant, with 57 studies and 169,433 participants. The studies spanned several populations such as college freshmen, seniors, veterans, HIV+ individuals, low-income caretakers, and the general population. This is among the largest pool of participants for a meta-analysis of mental health outcomes.
4. Genetic variation in health insurance coverage, International Journal of Health Economics and Management, December 2019.
Our work indicates that genes were an important contributor to explaining the variation in private health coverage status in the US population prior to the ACA. The genetic effects appear to be partly expressed through economic traits, especially employment and income. To the extent that individuals have a choice in having health coverage or differences in access to insurance depending on their employment and income—in contrast to a scenario of automatic universal coverage (such as in Canada or the United Kingdom)—genetic factors operating through such channels may continue to result in a proportion of the population being without health coverage. The reduced genetic variation when adding public coverage into our analysis and the evidence that employment and income explain nearly one third of the genetic variation supports this conclusion.
5. Prenatal and Infancy Nurse Home Visiting Effects on Mothers: 18-Year Follow-up of a Randomized Trial, Pediatrics, December 2019.
The [Prenatal and Infancy Nurse Home Visiting] program had no effect on reports of maternal substance abuse, depression, substance use, months worked since birth of their first child, or anxiety but produced long-term effects on public benefit costs for [Supplemental Nutrition Assistance Program, Aid to Families with Dependent Children, and Temporary Assistance for Needy Families]. Program effects on public benefit costs were most pronounced for mothers with [high psychological resources], an effect explained by the reduction in subsequent-child years.
6. The effect of college education on health and mortality: Evidence from Canada, Health Economics, November 24, 2019.
Determining whether education has a causal impact on health is important from a policy perspective. In this paper, we investigate the link between the two using both a dynamic microsimulation model and a major policy intervention that was implemented in Canada to foster college education among returning WW‐II veterans. COMPAS, the microsimulation model, shares many features with a similar model developed for the United States but focuses on the health trajectories of a representative cohort of Canadian men aged 30 and 31 in 2016.
Interestingly, both approaches find that the better educated benefit from greater health and longer life expectancy. According to COMPAS, the latter will require fewer hospital stays and fewer visits to specialists. Their additional years of life are expected to be free of limitations in activities of daily living. This is consistent with the quasi‐experimental approach according to which the college educated are less likely to suffer from heart diseases, cancer, and other major causes of death.