Determined Action Needed on Social Determinants
Authors: David U. Himmelstein, Steffie Woolhandler
Journal: Annals of Internal Medicine (2018)

Editorials17 April 2018Determined Action Needed on Social DeterminantsDavid U. Himmelstein, MD and Steffie Woolhandler, MD, MPHDavid U. Himmelstein, MDThe City University of New York at Hunter College, New York, New York, and Cambridge Hospital, Harvard Medical School, Cambridge, Massachusetts (D.U.H., S.W.) and Steffie Woolhandler, MD, MPHThe City University of New York at Hunter College, New York, New York, and Cambridge Hospital, Harvard Medical School, Cambridge, Massachusetts (D.U.H., S.W.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-0335 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In 2015 and again in 2016 (1), Americans' life expectancy decreased, the first multiyear decline since 1962 and 1963. Even before this recent dip, U.S. life expectancy lagged behind that of most other wealthy nations. Meanwhile, as health policy leaders shift payment from "volume" to "value," they have pointed to an upswing in virtually every quality metric they reward. In addition, journals announce a steady stream of life-prolonging technical advances.If medical care is improving, why are patients doing worse?Deteriorating social determinants of health—the key drivers of health status spotlighted in the American College of Physicians (ACP) position paper ...References1. Kochanek KD, Murphy SL, Xu J, Arias E. Mortality in the United States, 2016. NCHS Data Brief no. 293. December 2017. Accessed at www.cdc.gov/nchs/data/databriefs/db293.pdf on 2 February 2018. Google Scholar2. Daniel H, Bornstein SS, Kane GC; Health and Public Policy Committee of the American College of Physicians. Addressing social determinants to improve patient care and promote health equity: an American College of Physicians position paper. Ann Intern Med. 2018;168:577-8. doi:10.7326/M17-2441 LinkGoogle Scholar3. U.S. Census Bureau. Historical Income Tables: People. Washington, DC: U.S. Census Bureau; 2017. Accessed at www.census.gov/data/tables/time-series/demo/income-poverty/historical-income-people.html on 2 February 2018. Google Scholar4. Bricker J, Dettling LJ, Henriques A, Hsu JW, Jacobs L, Moore KB, et al. Changes in US family finances from 2013 to 2016: evidence from the Survey of Consumer Finances. Federal Reserve Bulletin. September 2017;103:1-43. CrossrefGoogle Scholar5. National Academies of Sciences, Engineering, and Medicine. The Growing Gap in Life Expectancy by Income: Implications for Federal Programs and Policy Responses. Washington, DC: National Academies Pr; 2015. Google Scholar6. The Sentencing Project. Fact Sheet: Trends in U.S. Corrections. Washington, DC: The Sentencing Project; 2017. Accessed at https://sentencingproject.org/wp-content/uploads/2016/01/Trends-in-US-Corrections.pdf on 2 February 2018. Google Scholar7. Wildeman C, Wang EA. Mass incarceration, public health, and widening inequality in the USA. Lancet. 2017;389:1464-74. [PMID: 28402828] doi:10.1016/S0140-6736(17)30259-3 CrossrefMedlineGoogle Scholar8. Christopher AS, Himmelstein DU, Woolhandler S, McCormick D. The effects of household medical expenditures on income inequality in the United States. Am J Public Health. 2018;108:351-4. [PMID: 29345995] doi:10.2105/AJPH.2017.304213 CrossrefMedlineGoogle Scholar9. Lauderdale DS. Birth outcomes for Arabic-named women in California before and after September 11. Demography. 2006;43:185-201. [PMID: 16579214] CrossrefMedlineGoogle Scholar10. Novak NL, Geronimus AT, Martinez-Cardoso AM. Change in birth outcomes among infants born to Latina mothers after a major immigration raid. Int J Epidemiol. 2017;46:839-49. [PMID: 28115577] doi:10.1093/ije/dyw346 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: The City University of New York at Hunter College, New York, New York, and Cambridge Hospital, Harvard Medical School, Cambridge, Massachusetts (D.U.H., S.W.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0335.Corresponding Author: David U. Himmelstein, MD, The City University of New York at Hunter College, 255 West 90th Street, 12A, New York, NY 10024; e-mail, [email protected]cuny.edu.Current Author Addresses: Drs. Himmelstein and Woolhandler: The City University of New York at Hunter College, 255 West 90th Street, 12A, New York, NY 10024. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAddressing Social Determinants to Improve Patient Care and Promote Health Equity: An American College of Physicians Position Paper Hilary Daniel , Sue S. Bornstein , Gregory C. Kane , and Metrics Cited byAnnotating social determinants of health using active learning, and characterizing determinants using neural event extractionAdverse social factors and all-cause mortality among male and female patients receiving care in the Veterans Health AdministrationAddressing Social Determinants of Health in the Care of Patients With Heart Failure: A Scientific Statement From the American Heart AssociationWhen Centers for Medicare & Medicaid Services Treats Throat Cancer Like PharyngitisAtul Grover, MD, PhD and Gayle Lee, JDMaking the Connection: Examining the Role of Social Support and Social Determinants in Chronic Disease Management 17 April 2018Volume 168, Issue 8Page: 596-597KeywordsAfrican American peopleHealth economicsHispanic peopleLife expectancyMortalityPregnancyPublic policyRiversSuicideTaxes ePublished: 17 April 2018 Issue Published: 17 April 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. 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