To address disparities in healthy life expectancy by race/ethnicity and socioeconomic status, the healthcare sector, government, business, and philanthropy need to take bold action to ensure that all Americans have access to safe environments, quality health care, nutritious food, and stable housing, a report from the Urban Institute argues.
Funded by the Citi Foundation as part of the institute's Urban Next50 initiative, the report, What Would It Take to Reduce Inequities in Healthy Life Expectancy? (64 pages, PDF), found that racial and socioeconomic inequities in the social determinants of health — including hunger, housing instability, social isolation, and exposure to violence and trauma — exist at every stage of life, accumulate over time, and affect both the length and quality of people's lives. As of 2017, the average life expectancy of African-American men was 4.5 years shorter than for white men and that of African-American women was 2.7 years shorter than for white women. The report also found that the gap in life expectancy between rich and poor Americans has been widening since the early 1980s.
To close the gap, the report's authors propose five mutually reinforcing "solution sets" involving action, investment, and innovation. They include the development and implementation of standardized approaches enabling the systematic assessment of health-related social needs; the establishment of community resource networks and platforms that connect providers and patients with social services; the incentivization of investments by Medicaid programs in non-medical services with health-sector payoffs; the establishment of sustainable mechanisms for operating and financing programs that address health-related social needs and yield cross-sector payoffs; and the alignment of organizational policies and activities in order to maximize effectiveness in addressing social needs.
The study also identified three "knowledge priorities" — areas where healthcare policy makers and practitioners need new data and analysis to accelerate promising solutions: evidence about high-priority health-related social needs with both high incidence and high potential for improving health and life expectancy when targeted; an actionable evidence base of proven interventions that resolve health-related social needs; and assessments of alternative cross-sector strategies for addressing social needs that integrate health, social service, and other systems.
"The history of social policy decisions in the [U.S.], which have often been shaped by underlying racism, has also exacerbated structural inequities that can affect health," the authors note. "[I]f health and longevity gaps persist between racial and ethnic groups as the United States becomes more diverse, the increasing burdens of chronic disease and premature death could further increase government spending on health care, potentially to the exclusion of other critical programs."