By Katie Kerwin McCrimmon
AURORA Investments in education would do far more to drive down health care costs than simply reforming the health care system, an expert on social determinants of health said Friday during a visit to Denver.
If there was one thing that modern medicine could do to improve health outcomes, it would be to solve the high school dropout problem, said Dr. Steven Woolf, of the Center for Human Needs at Virginia Commonwealth University.
Surveys show most people believe that hospitals or access to doctors determines how healthy people are. But, in fact, Woolf and his colleagues have found that social determinants ranging from education and poverty levels to jobs, neighborhoods and family support systems have a far bigger impact on a persons health. Health spending is completely out of whack with no more than 10 percent of more than $2 trillion a year being spent on preventive or behavioral health care, Woolf said.
Critics of the Affordable Care Act, which the U.S. Supreme Court is now weighing, complain that the law focuses too much on providing health insurance to the uninsured rather than driving down health care costs. While policy experts have plenty of ideas for trimming health expenses, Woolf said their lens is too narrow. They need to look outside the health care system and prevent people from getting sick and dying prematurely in the first place. Health disparities are profound in the U.S. with life expectancies for African Americans far lower than those for whites and people who live in affluent areas.
Woolf and his colleagues have done studies showing that improving lifestyles, neighborhoods and education for blacks could save far more lives than medical breakthroughs.
As someone interested in social factors, to me its a bit of a no-brainer to cut off the supply of disease thats flowing into the system, Woolf told about 100 health experts, doctors and students at the University of Colorados Anschutz Medical Campus in Aurora.
In fact, a study last year in Health Affairsfound that over the long term, encouraging healthier behaviors and improving environmental conditions dramatically saved lives while also driving down costs.
Woolf said hes alarmed when he sees governors and state lawmakers cutting education funding because their Medicaid rolls are swelling and they feel they have no choice. In fact, at a time when child poverty is at an all-time high in the U.S. and the economy is still sputtering, he thinks strengthening schools, reducing unemployment and investing in healthy neighborhoods could improve the health of millions while saving money over the long term.
Woolf and his colleagues modeled what would happen if every adult in the U.S. had some college education and found that higher educational attainment could save seven more lives than biomedical advances could save.
Studies in Virginia comparing some of the most affluent counties in the country to some of the poorest show that fixing disparities is complex and challenging.
Theres no magic wand, Woolf said.
Its unclear whether people in the more affluent areas live longer because they have access to better health care, stronger anti-smoking bans, easier access to physical activity, better schools and higher education attainment or healthier neighborhoods.
We know something is going on.
While its difficult to pinpoint exactly what changes would bring the greatest declines in premature death, Woolf points to better schools as the place he would start.
The only strategy that actually bends the costs curve and decreases spending is one that takes into account these social factors, Woolf said. Cutting back funding for education is only going to increase spending for medical costs in the long run.