An op-ed in the New York Times last week described the United States’ disproportionate spending on healthcare in comparison to other social services that have an impact on health – a characteristic that puts us in the minority, as one of only three industrialized countries. The chart below shows the ratios of healthcare:social service spending in the U.S. vs. peer countries (for details on these numbers and information on which countries are included, check out the published study).
In addition, when considering the combined spending on health and social services, the U.S. no longer leads the pack (as it does when examining only healthcare spending) – in fact, we come in 10th of 30 OECD countries examined. Furthermore, the authors of the study found that infant mortality, life expectancy, and potential years of life lost outcomes were significantly worse in countries where health-care spending was high and social-service spending low.
As the authors note, “The implication of our findings is that, if improved population health is our goal, then the United States should be looking beyond the health-care system to achieve that goal. Current reforms—targeting medical care and health services only—are unlikely to deliver that result.”
Amen. So, let’s look beyond the healthcare system. Each Monday starting today, I’m going to kick off our week here at occupy healthcare examining something outside the healthcare system that has enormous implications for our health (i.e. social determinants of health). I’ll try to end each post with a practical step or two you can take to address the topic at hand.
This week, let’s talk urban planning.
While this idea encompasses far more than just physical living space, physical living space is certainly a key component. Development decisions can affect our physical health (through walkability, green spaces, proximity to healthy foods, pollution caused by vehicular traffic), our emotional and mental health (length of commutes, spaces for social interaction) and societal well being (spaces for civic engagement, degree of segregation by race and income).
Many in the fields of urban planning and public health have come to this realization, epitomized by the smart growth movement, which holds among its principles:
*Mixed land uses
*Mixed income housing – providing a range of housing opportunities and choices
*Taking advantage of compact building design
*Creating walkable neighborhoods
*Preserving open space, farmland, natural beauty, and critical environmental areas
*Fostering distinctive, attractive communities with a strong sense of place
*Providing a variety of transportation choices
*Encouraging community and stakeholder collaboration in development decisions
Imagine the potential benefits:
*Less segregation could lead to more equitable policies across communities, and ultimately more equitable health and wellness outcomes
*More walkability and green spaces could increase physical activity
*Providing a variety of transportation choices could minimize our reliance on motor vehicles, and the resulting pollution and sedentary lifestyle
*Attractive communities with a strong sense of place could make us happier and more connected, reducing rates of depression
The list goes on. Moreover, many of these benefits have already been demonstrated through research. It is clearly time for us – and the U.S. – to invest in smart growth for healthier, happier communities.
So, what can we do? Today’s practical step: encourage use of health impact assessments in your local community when any kind of development project is being discussed, and advocate for state and federal laws that mandate or incentivize HIAs. HIAs provide a way to assess the health impact of any policy (development or otherwise) and would likely reveal the positive impact of smart growth, and the detrimental impact of development projects that don’t take into account smart growth principles. Certainly, there are complexities and challenges involved in conducting HIAs, and it is important to make sure they are being conducted in useful, cost-effective ways – but that is a topic for another post! Despite the complexities, I think HIAs when done well provide a concrete way to start thinking about the specific ways in which any policy that impacts the places we live also impacts our health and well being – and hopefully provide the impetus to start not just thinking about, but acting upon the results.
(This post is cross-posted at www.pursuitofpublichealth.com.)