Jim Kling

November 15, 2016

DENVER — Socioeconomic action that curbs poverty and improves quality of life for the poor is sound health policy, according to a new state-by-state analysis of healthcare.

"The public policies that are part of what people think of as community development and building the economy are health policies," said investigator Steven Woolf, MD, director of the Center of Society and Health at Virginia Commonwealth University in Richmond.

"They are probably going to have a bigger impact on health outcomes than what we do in healthcare, and I'm saying that as a doctor," he told Medscape Medical News.

Dr Woolf provided an overview of the Health of the States report here at the American Public Health Association 2016 Annual Meeting.

The 39 health outcomes include composite measures such as life expectancy, but also conditions that occur during the course of life, such as low birth weight and Alzheimer's disease. To assess the association between these outcomes and 123 variables, the researchers calculated Spearman's rank-order correlations.

A few findings stood out. For example, the highest rate of suicide mortality was consistently found in the Mountain States — Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, and Wyoming — which had 12.5 to 23.7 deaths per 100,000 people. Alaska and South Dakota also had rates in this range.

The public policies that are part of what people think of as community development and building the economy are health policies.

Some associations, such as those linking health outcomes to unhealthy behaviors and poverty, were expected. But other health-associated variables, especially those related to the built environment that people inhabit and their social environment, were a surprise, Dr Woolf pointed out.

The strongest correlation with health outcomes was health behaviors (r s, 0.87). But also strong were correlations with social and economic factors (r s up to 0.87), health systems (r s up to 0.84), and the physical and social environment (r s up to 0.84).

Social and economic factors were particularly influential. Of the 175 correlations considered "very high" (r s > 0.70), 69 involved social and economic factors and 48 involved the physical and social environment.

But it was the transit results that caught the eye of many members of the audience.

Table. Correlations With Government Spending on Mass Transit

Variable Correlation Coefficient
All-cause mortality –0.50
Traffic mortality –0.78
Obesity –0.51
Commuting by car –0.66


"I think state investments in areas you might not think of as related to health, such as transportation, is particularly interesting," said Melissa Maitin-Shepard, MPP, senior analyst with the American Cancer Society Cancer Action Network.

Spending on mass transit infrastructure was linked to less obesity, more physical activity, and a greater probability that people reported riding a bike or walking to work, she told Medscape Medical News.

"That doesn't happen by accident," Dr Woolf explained. "It's not because people in those states are more health conscious. To some degree, at least, it has to do with policy decisions to invest in making those communities places where people can avoid commuting by cars and places designed to promote physical activity."

The report will help policymakers to drill down to very specific correlations between health outcomes and individual parameters. With this, along with nine subanalyses that will be released in the coming months, policymakers can examine the effect of the choices they make.

"One of the real challenges is taking that massive amount of information and making it useful to policymakers. It seems like there's opportunity from this study to do that," said David Jones, PhD, assistant professor of health law, policy, and management at the Boston University School of Public Health, who attended the session.

The study only shows correlations, not proof that environmental or social changes improve health. Still, "these dots do connect in a logical way. More research is needed to confirm it, but in the meantime, policymakers have to make decisions and they have to work with the best data," Dr Woolf said.

Dr Woolf, Ms Maitin-Shepard, and Dr Jones have disclosed no relevant financial relationships.

American Public Health Association (APHA) 2016 Annual Meeting: Abstract 365730. Presented November 2, 2016.


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