Housing, Education and Income among the Critical Factors in a Population’s Health

By Sathya Achia Abraham

You may be surprised by what determines the health of a population -- it’s not so much what happens at a doctor’s office or a hospital as it is the environment in which our daily lives occur, according to Steven Woolf, M.D., M.P.H., professor in the Virginia Commonwealth University Department of Family Medicine, and director of the VCU Center on Human Needs.

“Our basic human needs, factors such as food security, housing, health, education and income, have more impact on health outcomes than most of the things that are done in clinical medicine,” Woolf said. “These factors are important parts of the puzzle in improving our health situation.”

For example, the death rate from diabetes is three times higher for people who have not graduated from high school than it is for people who have had some college education.

“A three-fold difference in death rates is something we can rarely achieve with what we do in medicine,” Woolf said. “As a physician I’m very impressed by that statistic. And many people feel that if we want to do something really important about health, it has nothing to do with pills and surgery, but more with dealing with high school drop-out rates.”

“We’re going through a very difficult time in our country right now. The economic stresses on the country have produced record changes in poverty rates, household income is declining, the disparity in income between the rich and the poor is widening, and our educational system is not ranked well compared to other industrialized countries - these are all public policy issues that policy makers and the general public are very concerned about, but there’s a tendency in our society to silo these issues into different categories,” he said.

Through the Project on Societal Distress, Woolf and a team of researchers at the VCU Center on Human Needs are taking a closer look at major causes of societal distress including food security, housing, health, education and income in the United States. By monitoring the prevalence of these factors – how often people and households experience these conditions – they are able to provide the public and policymakers with accurate data about the priority populations affected by these conditions. A key message is that non-health factors are major drivers of health outcomes. The work and data are reviewed by a panel of national experts in each category who provide advice to ensure data sources and metrics are chosen appropriately.

Read more: An Ounce of Prevention

“As we see poverty rates climbing and know that economic conditions have health implications, we can predict an actual tidal wave of disease coming to the health care system,” Woolf said.

According to Woolf, in the years to come there will be a larger burden of disease, not only in today’s adults, but in today’s children. These children are growing up under more stressful conditions and will be bringing a higher level of chronic disease to the health care system, he said.

“So that has important policy implications in and of itself, but it’s also important for today’s doctors and other health care leaders to understand that these factors are actually major drivers of the diseases that they care for, and dealing with education and dealing with economic policy, trying to correct social conditions, could have huge ramifications on reducing the disease burden,” he explained.

The center, which was established in 2007, is supported by grants from the W.K. Kellogg Foundation, the National Institutes of Health, and the Robert Wood Johnson Foundation.

Earlier this year, the VCU Center on Human Needs, together with the Robert Wood Johnson Foundation, unveiled the County Health Calculator, an online simulation tool that shows how many lives would be saved if a county, state, or the nation had the health benefits that exist in areas with higher levels of college education or income. The interactive tool allows users to move a slider bar to examine how mortality would be affected if more favorable socioeconomic conditions existed for the United States, or a specific state or county.