Urban Wire Why are some Americans more likely to fall off the “cliff of good health?”
Laudan Y. Aron, Lisa Dubay, Elaine Waxman
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Our collective health and well-being depend on aspects of our lives beyond the health care we receive at a doctor’s office or a hospital. Nurturing parents and caregivers, a strong education with dedicated teachers, stable housing in safe neighborhoods, access to good jobs that support families—these social determinants of health may matter as much, if not more, than our health care delivery system.

But why are some of us more likely to fall off the “cliff of good health,” which Dr. Camara Jones describes in our new whiteboard video?

The cliff of good health has a “third dimension”—shaped by structural forces rooted in race, gender, and economic inequality—that pushes some groups of people into poorer, sicker, and shorter lives. Addressing the differing conditions along the top of the cliff, and dismantling the societal policies and practices that perpetuate these inequities, is critical to creating an equitable path to good health.

The good news: we can change structures of opportunity and empower people and places. Researchers must examine the drivers of policies and practices (not just the effects) and how such drivers affect health inequality.

Research must also be geared toward action, so all kinds of community members and policymakers can be guided by strong and reliable evidence. Only by systematically attending to this third dimension of the cliff, and ensuring that all people are protected and empowered, will America achieve equitable health and well-being for all.


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The Urban Institute podcast, Evidence in Action, inspires changemakers to lead with evidence and act with equity. Cohosted by Urban President Sarah Rosen Wartell and Executive Vice President Kimberlyn Leary, every episode features in-depth discussions with experts and leaders on topics ranging from how to advance equity, to designing innovative solutions that achieve community impact, to what it means to practice evidence-based leadership.


Research Areas Health and health care
Tags Public health Social determinants of health
Policy Centers Income and Benefits Policy Center Center on Labor, Human Services, and Population