Social Stratification: The Real Cost of Health Care

Dr. James House ’65 visited campus to discuss his forthcoming book, “Beyond Health Care Reform: Social Determinants and Disparities in Health and America’s Paradoxical Crisis of Health Care and Health.”

Dr. James House ’65, the Angus Campbell Distinguished University Professor of Survey Research, Public Policy and Sociology in the Department of Epidemiology at the University of Michigan, visited Haverford for two days earlier this week. The purpose of his sociology department-sponsored visit was to give a public lecture and to lead a work-in-progress session with students—both on the topic of his forthcoming book, Beyond Health Care Reform: Social Determinants and Disparities in Health and America’s Paradoxical Crisis of Health Care and Health.

Dr. James House '65 and the cover of his 2008 book

A standing-room-only audience filled a Gest seminar room for the award-winning sociologist’s public lecture, which featured the same title as his book. And it’s no wonder he drew a crowd: health care reform is in the news and on many minds these days. But the focus of House’s research for the last 25 years isn’t on insurance coverage or single-payer systems or any other kind of traditional health care reform.  The key to alleviating the crisis in American health care, according to House, will come not from the supply side (providing more or better health care via insurers, hospitals and pharmaceutical companies), but from the demand side (building better health in the population).
House says that, despite spending exponentially more, Americans have worse health than any other comparably developed country. He quoted figures that show the U.S. spends 17% of its gross domestic product on health care currently, a figure that is expected to balloon to 20% by 2017. (For comparison’s sake: the U.S. spends less than 5% of its GDP on national defense.) But all that money isn’t making us a healthier country. We have an infant mortality rate closer to that of Poland or Chile than France or England. And we are ranked 50th in life expectancy, well below countries like Japan (5), Australia (9) and Canada (12). The real health care crisis, according to House, is not just that America’s economic model for health care is becoming unfeasible, but also that we are, in essence, paying more and getting less.
Though we often think of being healthy as being a biomedical issue, House says that health is produced by a set of social, environmental, psychological and economic factors. In fact, income and education are the key predictors of health, according to his research. A person with a less-than-high school-education in his/her 30s has the same health as a college-educated person in his/her 60s, says House.
The well-educated are living longer than ever, staying relatively healthy until later in life and are dying of chronic diseases (e.g., cancer) instead of infectious ones (e.g., TB). But they are also approaching the biological limit of how long medical advances can prolong their lives, according to House.  But there is a major opportunity, he says, to improve the health of the less-well-educated and the poor. By reducing that population’s exposure to risk factors (environmental, lifestyle, etc.), real strides could be made in improving their health and prolonging their lives. But this means, says House, that the real health care reform will have to come not from just expanding insurance coverage, but from enacting educational, socioeconomic and civil rights policies to narrow the gulf that education and income create. Improving health, he says, is a matter of reducing social disparities, and, to bring the debate back to health care reform, better health in the population will mean less spending on health care.
To read more about Dr. James House, see a recent profile on pg. 51 in the Haverford Magazine: