The voices of Urban Institute's researchers and staff
November 20, 2013

Americans are in poor health, but what’s really ailing us?

November 20, 2013


This morning the US Senate’s Committee on Health, Education, Labor and Pensions (HELP) is holding a hearing called “Dying Young: Why Your Social and Economic Status May Be a Death Sentence in America.” Is there much evidence for this provocative and alarming title? Sadly, the answer is a decisive “yes.”

Earlier this year, I wrote about a study I recently directed for the National Academy of Sciences and the Institute of Medicine that documented a large and growing US “health disadvantage” relative to other high-income countries. This disadvantage shows up in higher rates of disease and injury from birth to age 75 for men and women, rich and poor, across all races and ethnicities. Study after study confirms that the health of Americans is suffering dramatically and even slipping, and that real solutions to this situation lie far outside the health care system and the Affordable Care Act (ACA), as important as these are.

The real drivers of health in modern America are the non-medical or social determinants of health. These are things such as education, income, and neighborhood conditions that shape so many of our individual choices and behaviors—including behaviors such as smoking, diet, exercise, and driving—but also broader local, state, and national policies that shape our social and economic circumstances in very powerful and fundamental ways.

Unfortunately, for many of these social determinants, the United States is doing very poorly. Recent work at the Urban Institute shows this through our work on long-term unemployment, widening wealth inequality, and insecurity in children’s lives. Even social mobility, a cherished American ideal, is increasingly limited.

Rather than wait for breakthroughs in biomedical research, we can start attending to the social determinants of health through sound social and economic policies. Many other countries are doing this as part of their “health in all policies” approaches, and today’s HELP committee hearing suggests that the United States may finally be heading in this direction too.

In the months ahead, Urban Institute researchers and affiliated scholars will be contributing to this knowledge base and highlighting public policy implicitions for the social determinants of health.

Illustration by Daniel Wolfe, Urban Institute

As an organization, the Urban Institute does not take positions on issues. Scholars are independent and empowered to share their evidence-based views and recommendations shaped by research.




Your January study was excellent. I wonder if you have thought about the differences in relative mortality rankings for elderly versus non-elderly to try to quantify some of the relative factors explaining differences between the US and others. It seems that more time on Medicare equals better US ranking.