BUSPH researchers help highlight health inequity for Surgeon General’s report

Two Boston School of Public Health researchers—Salma Abdalla (SPH’16) and Dean Sandro Galea—were part of the team that authored “Community Health and Economic Prosperity: Engaging Businesses as Stewards and Stakeholders—A Report of the Surgeon General.” This report, which is available to read online, highlights the structural factors that have resulted in health inequities in the United States and calls on the private sector to help tackle these social determinants of health.

“While the report is framed to appeal to the private sector on why it should invest in the social determinants, at its core, this is a report that takes a thoughtful approach to the foundational forces that shape health and health disparities in the US,” said Abdalla.“It is encouraging that the Surgeon General’s office made the point that health is about much more than healthcare and that investing in the social determinants of health is also good for the economy. The core message is important—and perhaps even more important that these points were made during an administration that was inimical to them.”

The social determinants of health

Authors, Abdalla and Galea, wrote the first chapter of the report, which gives an overview of the social determinants of health (such as pollution and racism) and the resulting health inequities that arise from a lack of focus on prevention tactics.

According to the report, the U.S. spends more than twice as much on healthcare as peer countries, yet has the worst health, declining life expectancy, and huge gaps in health between populations. This fact illustrates the extent to which health is impacted more by conditions that prevent the need for care than the healthcare system itself.

From 1962 to 2017, the share of federal spending on social and economic investments decreased by 59%. In that same period, federal spending on direct cash transfer and healthcare-related costs increased by 162%. What this tells us is, that the government has been spending more money to treat health issues rather than preventing them by creating conditions that allow people to be healthy, such as:

• Education
• Safe, affordable housing
• Violence prevention
• Environmental protection
• Nutrition

This problem also affects the private sector since an unhealthy community means increased current and future workforce costs (such as absenteeism and health insurance) and less disposable income for consumers to spend on non-medical products. If a company works to make a community healthier, these factors can improve, and they’ll build better civic relationships and reputation.

“Hopefully, this conversation will ultimately lead to acknowledging health as a human right in the US, which in turn will have many implications on the type of policies and political choices made in this country,” Galea said.