Social determinants of health and Kenneth Arrow

Commenting on Adrianna’s post, Sean Parnell drew our attention to the second paragraph of the seminal paper by Kenneth Arrow:

It should be noted that the subject is the medical-care industry, not health. The causal factors in health are many, and the provision of medical care is only one. Particularly at low levels of income, other commodities such as nutrition, shelter, clothing, and sanitation may be much more significant. It is the complex of services that center about the physician, private and group practice, hospitals, and public health, which I propose to discuss.

If Arrow’s paper is not the most cited one in health economics, it surely must be close. (Google Scholar counts nearly 5,700 citations in the scholarly literature alone.) Indeed, the paper is often pointed to as the founding document of the discipline. It is, therefore, significant that Arrow was explicit in not addressing social determinants of health, while at the same time noting that they may be more important for low income individuals than aspects of the provision of health care or, I will add, the financing thereof.

Adrianna is right that we wonks have fetishized health care financing to the detriment of health care provision and, even more so, other areas of social policy likely more determinative for health of poor Americans. Surely there are–and if not, there should be–politically viable proposals that would or could more effectively address the health of poor Americans than a tweak or two of the Affordable Care Act. In your view, what are they?

Comments open until one week from the date of this post.


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