Getting to Better American Health Outcomes

“We should think about health inequity not as differences in outcomes across categories of individuals but as structural injustice that harms the health of everyone.”

The broad contours of America’s poor health are widely known. Once among the world leaders in life expectancy, we now trail all countries with comparable economies, erasing decades of progress and instead ranking highly in measures of chronic disease burden. This poor health, plus the dysfunctional way we finance and produce healthcare, feeds a massive amount of reactionary spending on personal healthcare, the highest amount in the world. But all this spending seemingly provides little value, and it does not even guarantee healthcare access for everyone.

Amid these problems, efforts to improve population health and health equity have focused primarily on healthcare systems, as well as on measuring health (in)equity primarily as social disparities—differences in health outcomes between socially better-off and worse-off categories of individuals. Although well intentioned, these efforts have had little measurable effect in improving outcomes.

It is in this setting that my new book, Equal Care: Health Equity, Social Democracy, and the Egalitarian State, argues for a different way to approach these fundamental problems. In my work as a primary care doctor and health researcher over the last fifteen years, it has become clear to me that social conditions are the real drivers of population health, and that health inequity stems from institutions, policies, and programs that undermine everyone’s fundamental moral equality. Ultimately, we should recognize, as I write in my book, that “health inequity is social failure embodied, and the only true cures are political.”