There has been plenty of debate among both Republican and Democratic presidential candidates as to the future of health care. Will the Affordable Care Act stand? Should Medicare be restructured? What can the government do about soaring drug costs? But what’s been missing from the discourse about health care is an even more fundamental issue: health.
Compared with people in other rich nations, Americans die younger and have higher rates of disease and injury. This health disadvantage is pervasive, affecting all races, genders, ages, and classes. These disparities can’t just be fixed by health care coverage or treatment alone. They require thinking about the social and economic factors that promote or derail health—factors such as income, education, housing, the nature of work, and the kinds of environments that shape our daily lives.
In earlier debates, we wanted candidates to address declining life expectancy for some American women. Today, we have a few more questions about health and well-being, questions that our next president must be prepared to answer.
Over the past three decades, the uninsured rate among children has fallen drastically, with only 5.4 percent currently lacking health insurance coverage. Despite this progress, there remain important disparities in children’s health and well-being: higher-income children fare better than those in middle-income families, and poor children face the biggest health challenges. These differences begin in childhood and persist and widen throughout life. Moreover, the environments that promote health also vary by family income.
Given that access to health care is unlikely to explain these differences, what policies would you implement to give all American children a better shot at a healthy and productive life?
Disconnected youth and the transition to adulthood
An estimated 5.5 million youth ages 16 to 24 (about 1 in 7) are neither working nor in school; they are largely disconnected from their communities and from stable pathways into a healthy and productive adulthood. African American and Latino youth are particularly at risk.
Adolescence is an especially important time in life for mitigating risk and ensuring that young Americans get a strong and healthy start in their adult lives. Getting youth on a path to completing school and working or pursuing a college degree is key to their own lifelong health, that of their future families, and the well-being of their communities, and the nation’s future.
How would you prevent youth from becoming disconnected in the first place? How will you create multiple pathways that support young people in building skills, finding work, and strengthening their communities?
Working is obviously important for economic security, but the ways in which we work have important consequences for health and well-being—not just for workers, but also their families and children. Many workers get little advance notice about their work schedules; unpredictable or on-call work hours make it difficult to plan for child care or care for an elderly or disabled family member. This unpredictability creates stress and often erratic sleeping schedules, both of which can undermine health.
Inconsistent scheduling can also have serious consequences for the health and well-being of families and their children, both because of the stress on the family and because parents may struggle to create family routines, spend time with their children, cook healthy meals, and take their children to the doctor.
What steps would you take to help support working families, not just with jobs that pay a living wage, but the need to balance work with caregiving responsibilities for children, aging parents, or a disabled family member?
Housing affordability and economic vulnerability
Across the country, 50 percent of renters are burdened by their housing costs. As a result, many low-income renters in this group must make tradeoffs between housing costs and other basic needs, such as food, transportation, health care or medicine, and retirement savings. Limited access to affordable, quality housing also means that many families must live in low-quality environments that might expose them to toxins or other stressors, including fewer neighborhood amenities like quality schools or safe parks. Predictably, these choices can have serious negative consequences for both short-term and long-term health.
Given that rental households will grow by 6.5 million from 2015 to 2025 and an estimated 2.2 million of these households will be spending more than a third of their income on rent, what policies would you implement to address the growing housing affordability crisis in America?