Social Determinants

Good health is the product of access to quality medical care and sound public health policy. Effective policies that improve health outcomes include the Earned Income Tax Credit, supportive housing, and access to good public education. Per capita spending on medical care and social services in America and in European countries is about the same, but the US spends much more on medical care, while Europe spends more on social services. Europeans have longer life expectancy and better health statistics than Americans.

Longevity and future medical innovations

Disparities exist in life expectancy just as it does in income. The top 20% live 11 years longer than the bottom 20%. Even in comparison to the median, the top 20% are expected to live 4 years longer. This disparity may become even larger with future advances in medical care, such as gene tweaking. They will likely be very expensive, and it’s possible that they may therefore only be accessible to the rich. There will be moral and ethical trade-offs to consider whether health insurance should cover these treatments, who is covered and who is not, and whether they are worth the increase in medical care spending in lieu of investing in social determinants.

More Health

The hallmark of good population health is a world in which people are connected to their communities, have a chance to make good decisions about their health, and have the resources to do so. The perspective in the field of health economics is changing towards focusing on better health outcomes for the population, instead of primarily on providing medical care and how to pay for it. What is a better return on investment? Do healthier lives come from more investments in things like education, income, early childhood, social services, and preventive medicine? Or do they come from more investments in high-tech medical innovations?

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Dr. James Knickman is the Director of the Health Evaluation and Analytics Lab (HEAL), a joint initiative of the Health Policy and Management Program at NYU Wagner and Department of Population Health at NYU Langone. He is also a Senior Research Scientist at the NYU Robert F. Wagner Graduate School of Public Service and a Clinical Professor in the Department of Population Health at NYU Langone.

Dr. Knickman was previously the president and CEO of the New York State Health Foundation, a position he held since May 2006. The Foundation focuses on high impact interventions to bring about measurable improvements in New York’s health system. Prior to that appointment, he was Vice President for Research and Evaluation at the Robert Wood Johnson Foundation (RWJF).

He has published extensive research on issues related to the financing of health care and long-term care and improving services for frail elders, homeless families, and individuals with HIV. Dr. Knickman is the co-author of Jonas & Kovner’s Health Care Delivery in the United States, a widely used textbook on health policy and management.

Follow James Knickman on Twitter @JimKnickman.