Which causes more deaths in the United States: heart attacks or failure to graduate high school? Strokes or racial segregation? Lung cancer or poverty? The surprising answer is that poverty and its attendant deprivations are deadlier than disease.
For years, poverty has been cited as a contributing factor to poor health. But a recent study goes further, quantifying how many people poverty kills per year -- 133,000 in 2000 -- in the same way experts attribute deaths per year to, say, smoking. The report also quantified deaths attributable to non-income aspects of poverty, such as low levels of educational attainment, income inequality, racial segregation, and lack of social support. The new findings in the American Journal of Public Health "argue for a broader public health conceptualization of the causes of mortality and an expansive policy approach that considers how social factors can be addressed to improve the health of populations." We could not agree more.
Tackling social and economic disparities and improving the conditions in which people are born and raised hold the greatest promise for longer, healthier lives. This is not to say that health care and health-care reform are unimportant to human well-being; they are critical. Universal health coverage is vital both to saving lives and to addressing the leading cause of bankruptcy among U.S. households: medical bills. Health insurance contributes to both health security and economic security, essential foundations of a freely chosen life of value. In fact, a study this month by the National Bureau of Economic Research showed that when poor people are given medical insurance, they visit doctors more often, feel better, are less depressed, and are better able to maintain financial stability.
Though medical treatment is essential once we are sick or hurt, medicine's capacity to prevent chronic disease, the leading cause of death in the United States, pales compared to the power of social and economic factors, such as education and standard of living, to influence our health.
Education confers well-documented health advantages, making high-quality universal preschool education, quality K-12 education, and greater equity in access to and completion of college education good health policy as well as good education policy. Education enables more fulfilling work with greater stability, control, and freedom, which facilitates longer lives.
Likewise, policies that lift families out of poverty and help them build assets -- such as the Earned Income Tax Credit, childcare subsidies, food stamps, job training, and increases in the minimum wage -- are also policies that foster health resilience by reducing stress and increasing resources available for building wellness. Policies on housing and crime prevention that improve neighborhood safety and walkability, and community empowerment efforts that strengthen agency and self-determination, also improve health. For people with serious mental illnesses, supportive housing helps unlock both better health and greater participation in society.
The evidence is clear. Poverty kills. Addressing the underlying social and economic conditions that breed poverty and ill health -- in other words, better policy, not better medicine -- is the solution.