Combatting Social Determinants of Health with Policy Changes

Tackling care disparities and social determinants of health calls for policy interventions centered on health equity, economic mobility, access to care, affordable housing, safe learning environments, and health-promoting excise taxes, according to a new report from Trust for America’s Health. 

Trust for America’s Health, a non-partisan advocacy organization, outlined federal and state-level policy recommendations in its report, all aimed at improving health equity while reducing healthcare spending and care disparities. 

"The COVID-19 pandemic put a spotlight on the role that social and economic conditions play in health and gives policymakers an opportunity to build an improved social supports and public health system," J. Nadine Gracia, MD, MSCE, president and CEO of Trust for America's Health, explained in a press release. 

"Focusing solely on individual behavior will not solve America's health crisis. Building healthy and thriving communities and advancing health equity require improving the social and economic conditions that shape health. Only then will everyone have a fair and just opportunity to enjoy optimal health."

Health inequities and systemic care disparities are partly a result of decades of inequitable policies, Trust for America’s Health contended. Some policies were intentionally discriminatory, while others had unintended but detrimental side effects. 

The organization asserted that while policy decisions have the power to inflict harm, they also have the power to uplift marginalized populations, close disparity gaps, and improve health outcomes for all. 

“Understanding how policy decisions can be used as a tool to remove existing barriers and create new opportunities for building healthy and equitable communities is critically important to developing equitable policy that promotes health for all individuals and communities, not just a subset,” the report maintained. 

With this in mind, the latest Trust for America’s Health report introduced policy recommendations that it argued will enable health equity and lessen the negative impacts of social determinants of health. 

For example, access to high quality healthcare can be countered by widespread Medicaid expansion, the report stated. Many states already expanded Medicaid, and it has been linked to less medical debt collections. 

About four million uninsured adults would gain coverage if the states that have not yet expanded chose to move forward with Medicaid expansion, the report continued. Medicaid expansion is tied to improving access to care, reducing mortality rates among adults and infants, and increasing access to dental and behavioral health services.  

The report also cited financial benefits, including reducing total state spending, reducing uncompensated care, and increasing the financial well-being of Medicaid beneficiaries. 

Trust for America’s Health also recommended increasing access to early childhood education programs, National School Lunch and School Breakfast Programs, and social-emotional learning programs to promote healthy learning environments for children. 

COVID-19 exposed stark economic disparities and hardship across the country, specifically for marginalized populations. To promote economic mobility, the report recommended expanding the Earned Income Tax Credit (EITC), a credit offered to low-income workers to boost economic security. 

“Because so many low-wage workers are experiencing economic hardship during the COVID-19 pandemic, economic relief policies such as the EITC can serve as a mechanism to provide direct financial support for eligible workers,” the report reasoned.

On top of the economic benefits, the report provided evidence that EITC policies can positively impact health. There is a correlation between mothers who receive EITC benefits and increased breastfeeding rates, reduced infant mortality, and better overall health for both the mother and child.

“Mothers living in a state that recently enacted or increased a state EITC reported having less mental stress and lower smoking rates during pregnancy, both of which also contribute to improvements in birthweight,” the report revealed.

In addition to enacting policies that ensure economic security, the report recommended expanding the Low-Income Housing Tax Credit (LIHTC) program to ensure access to affordable housing. Low-income families who struggle to pay for rent are less likely to have consistent medical care and more likely to postpone treatment, leading to poor health outcomes.

Expanding this program through policymaking would improve health outcomes and increase economic mobility, the report suggested.

Enacting health-promoting excise taxes may also be a key to curbing poor health outcomes, the report contended. Trust for America’s Health recommended taxing unhealthy products like sugar-sweetened drinks, alcohol, and tobacco to encourage healthy choices and reinvest funds in chronic disease prevention programs. 

Overall, the report maintained that equitable policymaking is often directly correlated with better health outcomes and financial gains. It is now up to the policymakers themselves to enact change.