Understanding the Impact of Economic and Social Conditions on Health

A recent article by Catherine Ettman, PhD, an assistant professor in Health Policy and Management, published in the JAMA Forum examines how emerging evidence highlights the significant influence of economic and social conditions on population and individual health. These conditions, known as social determinants of health (SDOH), include factors such as place of residence, employment, and education. Recognizing the importance of these determinants suggests that policy interventions targeting SDOH can substantially improve health outcomes. However, crafting policy solutions that address these determinants and are acceptable to non-health policymakers presents a challenge. 

One way to guide policy thinking is through an assets framework, which identifies three types of assets that shape population health: financial assets, physical assets, and social assets. By understanding how these assets influence health, specific non-health interventions can be devised to improve health outcomes. 

Financial Assets 

Financial assets encompass income, savings, credit, and insurance. Wealth, more than income alone, is a crucial indicator of economic well-being and a predictor of health. Studies show lower debt and higher credit scores are associated with better health. Notably, financial disparities between racial and ethnic groups are more pronounced regarding wealth than income. For instance, the income gap between white and Black families is 2 to 1, but the wealth gap is 6 to 1. 

Addressing how financial assets affect health suggests non-medical interventions like wealth accumulation strategies. Policies such as baby bonds (savings accounts for newborns redeemable in adulthood) could help low-wealth groups build financial assets, leading to better health. Additionally, initiatives like cash transfers and insurance benefits to improve wealth could positively impact health. 

Physical Assets 

Physical assets include material possessions that provide shelter (homes), mobility (cars), and communication (devices and the internet). Homeownership, for example, offers stable housing, better living standards, and psychological benefits, all of which contribute to positive health outcomes. Conversely, financial strain from mortgage payments can negatively impact health. Homeownership also helps individuals accumulate capital to leverage to generate health benefits. 

Access to technology and the internet facilitates social interactions and economic opportunities, enhancing health. Policies like the U.K.'s Right to Buy, which subsidized home purchases, improved health indicators. Similarly, expanding access to high-speed internet in the U.S. could enhance access to health services. 

Social Assets 

Social assets include attributes that influence an individual's role and status in society, directly affecting health and providing access to other assets. These include education, marital status, and religious affiliation. Education promotes positive health behaviors such as regular exercise and healthy eating, while marriage is linked to reduced alcohol consumption and longer lifespans. Social support from religious affiliations and marriage also contributes to better health. 

Disparities in social assets contribute to health inequalities. For example, minority groups in the U.S. often have lower educational attainment and poorer health. Policies promoting affordable, quality education can improve health across the lifespan. Legalizing same-sex marriage has allowed LGBTQ+ individuals to access health insurance and other marital benefits, enhancing their health. 

Linking SDOH to Effective Policy Action 

A significant challenge in linking SDOH to effective policy is the abstract nature of social determinants. An assets framework can help pinpoint actionable policies that improve health. While not directly providing health benefits, financial resources facilitate access to essential resources like housing, food, education, and employment, which are critical for health. Although health policy often focuses on improving access to health services, expanding policy to include interventions that strengthen the assets producing health is crucial for comprehensive health improvement. 

By adopting the framework of an asset, policymakers can identify non-health interventions that bolster financial, physical, and social assets, ultimately leading to better health outcomes for populations.