Understanding what it takes to improve the health of people and communities
Compared with people in other rich nations, Americans die younger and have higher rates of disease and injury at all ages from birth to 75. This health disadvantage is pervasive—affecting men and women, young and old, rich and poor, and all races and ethnicities in the United States—and manifests itself across multiple areas of health, from infant mortality and teen pregnancies to traffic fatalities and heart disease.
Health disparities within the United States are even greater. They are found across populations (e.g., education and income, race and ethnicity) and across geographic areas (e.g., states, counties, cities, and even neighborhoods). Many of these health differences appear early in life, increase over a person’s life, and can disrupt ideal developmental trajectories and access to opportunity.
These differences are likely to be rooted in a wide range of factors: differences in access to health care and public health services; individual behaviors, such as diet, physical activity, and gun ownership; social determinants of health, such as income, poverty, and education; the quality of physical and social environments; and public policies and societal values.
The Urban Institute’s Social Determinants of Health initiative draws upon expertise across our research centers to investigate how these nonmedical (or social) factors are affecting the health of Americans. Our participating scholars include experts in the programs and policies that shape these factors, such as housing regulations, job training programs, food and nutrition assistance, tax credits, and crime prevention. We dig deep to understand complex causal pathways that span a person’s life and that play out in different ways over time and place. We also assess the potential of policies and programs both inside and outside the health care system to drive improvements in health.
Our research includes rigorous statistical analysis that disentangles the contributions of various social, behavioral, and economic factors to health outcomes. We estimate the costs and benefits of interventions aimed at improving health by addressing these factors. In addition, we conduct more intensive qualitative studies to better understand how health-related behaviors are affected by families, neighborhoods, and work or school environments—and which changes in these environments can make the biggest difference.
When the Department of Housing and Urban Development (HUD) began demolishing the country’s most severely distressed public housing projects, the Urban Institute launched a study to find out what was happening to the displaced residents. Our research revealed very high rates of poor physical and mental health among public housing residents and that many of those in the poorest health were falling through the cracks during the relocation and redevelopment process.
HUD responded by requiring local housing authorities to partner with health care providers and provide better support services for all relocated residents. Today, our Housing Opportunity and Services Together (HOST) demonstration continues that approach. HOST is testing strategies for linking intensive support services with housing subsidies to improve the health and long-term life chances of vulnerable youth and adults.
Broadening the evidence on what it takes to improve Americans’ health is critical to future growth and prosperity. Many other countries are achieving far superior health outcomes for about half the per capita costs. If the United States could match this performance by effectively addressing the social determinants of health, it could improve the population’s physical health, reduce health inequalities, and increase the social, economic, and fiscal health of the nation as a whole.