‘At least I have my health” is a phrase we use to signify that, of all the items we possess, good health is the most important to our personal well-being. But we often don’t consider the important role good health plays in our economic well-being too.
The social determinants of health and economic well-being will be a key topic in my May 22 commencement speech to graduates of the Jefferson College of Health Professionals and College of Pharmacy. I am sure these grads look forward to taking their places in our healthcare system. But, I wonder, do they appreciate their importance in our economic future? Indeed, helping households and communities achieve good physical health is critical to promoting economic growth.
To be clear, I am not talking about increasing access to health-care providers and insurance. I leave that to the politicians. I am talking about a holistic approach to good health in all of our communities.
Where you live goes a long way in determining how you feel. Being able to see a doctor or dentist or go to an emergency room is important, but so is having a home free from lead or asthma irritants. Most of us know we can probably eat better or should drop a few pounds, but a healthy diet is a challenge when you live in a “food desert,” with little access to fresh produce and unprocessed foods.
It is no surprise that poorer households have worse health outcomes. Financial instability raises physical stress levels. Poor adults are twice as likely as affluent adults to have diabetes and they experience coronary heart disease at a rate that is nearly 50 percent higher than that of the most affluent adults.
In recent research, economists Anne Case and Angus Deaton traced the rising mortality rates among middle-aged, non-Hispanic whites to increases in deaths from drug overdoses (including opioids), suicide, and alcohol-related diseases. They labeled these fatalities “deaths of despair,” because stagnant wages and fewer work opportunities have created a culture of hopelessness for those who are less educated and less skilled in our economy.
We as a nation must address this link between social determinants and physical health.
When Dr. Tom Friedan, former director of the U.S. Centers for Disease Control and Prevention, created “the health impact pyramid,” he found socioeconomic factors were the base of the pyramid – the area where money spent has the largest impact on health. So, investing in better housing, education, and job training in our poorer communities offers a “bigger bang for the buck” than money spent on expensive items such as clinical interventions. It may be a key way to slow the growth in health-care spending, which now accounts for almost 18 percent of our economic output.
The Federal Reserve is working to understand the interconnectedness of social factors, physical health, and economic well-being. Here at the Philadelphia Fed, our new initiative, the Economic Growth and Mobility Project, is championing research and best practices that move individuals, families, and communities out of poverty and into prosperity. Key to this effort is understanding how poverty is diminished – or worsened – by the health circumstances in our communities in Pennsylvania, New Jersey, and Delaware.
Elsewhere in the system, the San Francisco Fed is leading a venture with the Robert Wood Johnson Foundation to address ways to build and sustain healthy communities. Additionally, regional Fed banks bring together participants in community development, public health, and health care to share research and best practices. Just last year, in partnership with the University of Pennsylvania’s School of Public Health, the Philadelphia Fed hosted a forum on the topic “financial health is public health.” Finally, we are exploring how banks can leverage their Community Reinvestment Act commitments to support healthy outcomes such as financing a new water treatment plant or rehabbing housing to remove lead paint or mold.
The 2017 graduates at Jefferson may not realize it, but when they work in health care they will not just be providing help. They will also be creating a more optimistic future, not just for their patients, but for all of us. That’s because healthier people are more likely to be in the labor force and earning a paycheck. Businesses gain from fewer sick days and improved productivity. Less government money is spent on social programs and more funds come in as tax revenues, providing money for infrastructure and debt repayments.
If the physical well-being of our most vulnerable neighbors can be improved, we will all benefit.