Advertisement

Health Institutions and the Political Determinants of Health

      Health institutions, such as hospitals and hospital systems, are investing in programs to address upstream drivers of health. These drivers include the macrolevel forces that comprise social-structural influences on health institutions; government policies; and the social, physical, economic, and environmental factors that affect health. Historically, health institutions have mostly invested in mitigating the harmful aspects of social determinants of health—the most publicized upstream driver of health—for their patients. From 2017 to 2019, they collectively spent $2.5 billion on programs targeting the social determinants of health.
      • Horwitz LI
      • Chang C
      • Arcilla HN
      • Knickman JR.
      Quantifying health systems’ investment in social determinants of health, by sector, 2017-19.
      Although only a tiny fraction of the $100 billion in profit that was generated by U.S. hospitals in 2019,

      AHA hospital statistics. AHA Data. https://guide.prod.iam.aha.org/stats/. Updated 2022. Accessed April 4, 2022.

      investments in this area are significant given that social, economic, and environmental factors account for 80% of a person's modifiable contributors to health outcomes.
      • Hood CM
      • Gennuso KP
      • Swain GR
      • Catlin BB.
      County health rankings: relationships between determinant factors and health outcomes.
      Health institution investment and activity in the political determinants of health (PDoH), an even more fundamental and perhaps impactful driver of health, are therefore critical to understand.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Horwitz LI
        • Chang C
        • Arcilla HN
        • Knickman JR.
        Quantifying health systems’ investment in social determinants of health, by sector, 2017-19.
        Health Aff (Millwood). 2020; 39: 192-198https://doi.org/10.1377/hlthaff.2019.01246
      1. AHA hospital statistics. AHA Data. https://guide.prod.iam.aha.org/stats/. Updated 2022. Accessed April 4, 2022.

        • Hood CM
        • Gennuso KP
        • Swain GR
        • Catlin BB.
        County health rankings: relationships between determinant factors and health outcomes.
        Am J Prev Med. 2016; 50: 129-135https://doi.org/10.1016/j.amepre.2015.08.024
        • Dawes Daniel
        The Political Determinants of Health.
        Johns Hopkins University Press Books, Baltimore, MD2020 (Published March 24. Accessed January 5, 2022)
        • Martin A
        • Raja A
        • Meese H.
        Health care-based voter registration: a new kind of healing.
        Int J Emerg Med. 2021; 14: 26https://doi.org/10.1186/s12245-021-00351-y
        • American Hospital Association
        Americans view hospitals very favorably, support additional financial aid in new coalition public opinion polling.
        American Hospital Association, Washington, DC2020 (Published July 16. Accessed April 4, 2022)
      2. Washington S 200. A 501 tax-exempt, NW charitable organization; 1300 LS. Top Spenders. Opensecrets. https://www.opensecrets.org/federal-lobbying/top-spenders?cycle=2019. Accessed April 4, 2022.

      3. Guth M, Artiga S, Pham O. Effects of the ACA Medicaid expansion on racial disparities in health and health care. San Francisco, CA: Kaiser Family Foundation, 2020. https://www.kff.org/medicaid/issue-brief/effects-of-the-aca-medicaid-expansion-on-racial-disparities-in-health-and-health-care/. Published September 30. Accessed April 23, 2022.

        • Taylor L.
        Housing and health: an overview of the literature.
        HealthAffairs, Bethesda, MD2018 (Published June 7. Accessed April 23, 2022)
        • Schweich E.
        Essential hospitals get out the vote.
        America’s Essential Hospitals, Washington, DC2020 (Published October 8. Accessed January 5, 2022)
      4. 2021 AHA advocacy agenda.
        American Hospital Association, Washington, DC2020 (Published January 30. Accessed April 4, 2022)
        • Mathematica
        Boston Children’s Collaboration for Community Health: 2020 Report.
        Boston Children’s Hospital, 2020 (Accessed January 5)
        • Knopf T.
        Rural hospital CEOs call for Medicaid expansion.
        North Carolina Health News. 2019; (April 29.) (Accessed January 5, 2022)
      5. Letter to Mayor Janey Calling for a Citywide Eviction Moratorium, sponsored by Massachusetts Coalition for Health Equity.
        MassInsider. 2021; (Published October 8, 2021. Accessed April 4)
        • Gardizy A.
        Mass General Brigham backs extra tax on some real estate transactions to fund affordable housing.
        BostonGlobe.com. 2022; (January 19.) (Accessed January 26, 2022)
      6. Voting and registration in the election of November 2020. United States Census Bureau. https://www.census.gov/data/tables/time-series/demo/voting-and-registration/p20-585.html. Updated October 8, 2021. Accessed January 5, 2022.

        • Guth Madeline
        • Garfield Rachel
        • Rudowitz Robin
        The effects of Medicaid expansion under the ACA: studies from January 2014 to January 2020.
        Kaiser Family Foundation, San Francisco, CA2020 (Published March 17. Accessed April 4, 2022)