Social Determinants of Health in the News
By Kate Raphael
We’ve done several roundups of SDOH in the news. Here’s another collection of excerpts from six stories that caught our eye.
1. Permanent Supportive Housing for Homeless People—Reframing the Debate, The New England Journal of Medicine, December 2016.
Although some advocates may see [Housing First’s lack of net cost savings] as disappointing, we believe [the findings] present an opportunity to reconsider the problems inherent in applying a cost-savings outcome metric to Housing First. First, creating expectations of cost savings imposes a double standard. In general, there’s no expectation that health and social services save money. Instead, we invest in treatments, programs, and services that deliver benefits at an acceptable cost, often judged on the basis of quality-adjusted life-years gained. Insisting on net savings from Housing First programs implicitly devalues the lives of homeless people.
Second, a focus on savings could overshadow other metrics of success and imply failure when Housing First programs achieve their primary aim but don’t produce net savings. Finally, overemphasizing the cost dimensions reduces a complex social situation to a financial calculation. Advocates and researchers shouldn’t proceed from a view that Americans are so uncaring that they will support responses to homelessness only if they deliver net monetary gains. A persuasive and more sound argument favoring Housing First would instead draw from scientific research, economic considerations, and moral values.
2. Installing air filters in classrooms has surprisingly large educational benefits, Vox, January 8, 2020.
The impact of the air filters is strikingly large given what a simple change we’re talking about. The school district didn’t reengineer the school buildings or make dramatic education reforms; they just installed $700 commercially available filters that you could plug into any room in the country. But it’s consistent with a growing literature on the cognitive impact of air pollution, which finds that everyone from chess players to baseball umpires to workers in a pear-packing factory suffer deteriorations in performance when the air is more polluted.
If Gilraine’s result holds up to further scrutiny, he will have identified what’s probably the single most cost-effective education policy intervention — one that should have particularly large benefits for low-income children.
3. In Focus: CHRONIC Care Act Prompts Some Medicare Advantage Plans to Incorporate Social Services, The Commonwealth Fund, January 9, 2020.
Under the law, which kicks in fully this year, Medicare Advantage plans can opt to pay for benefits like healthy meal delivery (e.g., low-salt dinners for those with heart failure), transportation to the pharmacy or grocery store, home modifications to accommodate walkers and wheelchairs, and other services that may promote health but are not strictly medical in nature.
While health plans were previously allowed to offer supplemental benefits to prevent, cure, or diminish a disease, like a diabetes management class, now they can offer services designed to improve functioning, ameliorate symptoms, and otherwise reduce use of emergency departments or hospitals. Before, health plans were allowed to deliver meals to members after they’d been hospitalized; now, they can provide meals at any time if they think it could help keep people out of the hospital.
4. College Access and Adult Health, NBER Working Paper Series, January 2020.
Making use of changes in the accessibility of 2 and 4-year colleges over time and across states with Census and ACS data, we find that public 2- year colleges per capita at the time an individual was 17 years old has a significant effect on their schooling and, for some groups, adult earnings and employment. Our estimates imply substantial market returns to higher education, which is consistent with many papers in the returns-to-schooling literature. Furthermore, using NHIS data, we find that public 2-year access improves the health behaviors and outcomes later in adulthood—it reduces the likelihood of smoking, increases exercise frequency, and is associated with better self-reported health.
5. Association of Social Mobility With the Income-Related Longevity Gap in the United States: A Cross-Sectional, County-Level Study, JAMA Internal Medicine, January 21, 2020.
We hypothesized that social mobility may play an important role in explaining income-related disparities in longevity. Social mobility reflects the ability of individuals to exceed the socioeconomic status of their parents. It is distinct from income inequality; areas with high levels of income inequality may have different rates of social mobility. Studies have demonstrated that social mobility in the United States varies greatly across space, with some US Census regions, such as the Northern Plains, affording high rates of mobility, whereas others, mainly in the South, afford little. A growing body of literature suggests that living in areas with low social mobility may harm individuals’ health by reducing their beliefs about future well-being, consequently increasing stress or diminishing the motivation to engage in healthy behaviors. The consequences of low area-level social mobility are likely largest for poorer individuals, for whom the potential for upward mobility is most salient. […] We found that greater county-level social mobility was associated with smaller county-level longevity gaps by income in the United States.
6. Medicaid Utilization and Spending among Homeless Adults in new Jersey: Implications for Medicaid-Funded Tenancy Support Services, The Milbank Quarterly, 2020.
In spite of its limitations, this study provides important new information relevant to the design of Medicaid-funded [tenancy support services (TSS)] for homeless persons. Using novel linked statewide data, we found that a significant number of very high–need Medicaid enrollees were homeless and could benefit from the expansion of supportive housing programs. Comparisons of homeless populations to demographically and clinically similar nonhomeless populations indicate that new investments in TSS may potentially reduce use of expensive and avoidable hospital services. Additional research on program strategies is needed to identify the extent to which TSS can achieve that potential in this very complex population.