Making Americans Healthier: Social and Economic Policy as Health Policy

Preface

Preface Three observations motivated the writing of this book: • First, gaps in health between social and economic groups—by education, income , wealth, neighborhood, and race, for example—are massive. These gaps have persisted for decades. They are not narrowing, despite growing awareness at all levels of government and throughout the clinical and research communities that health disparities pose central challenges to American society . • Second, our nation spends billions of dollars each year on policies and programs that seek to improve social and economic outcomes. However, the policy communities influential in these domains have largely adopted programs without considering the potential substantial effects these may have on individual and population health. Substantial benefits—or perhaps costs, in the case of policies that worsen health status—are therefore not considered . • Third, our nation continues to grapple with rising health care costs which are unparalleled across the globe. At the same time, by most indicators American population health has declined relative to that of many other nations. Taken together, we believed that these three observations justified a concerted effort to assess the effects of social and economic policies on health, and this book is the product of our efforts. The chapters include research in six policy domains: education policy, income transfer policy, civil rights, macroeconomic and employment policy, welfare policy , and housing and neighborhood policy. While policies in other domains were considered, these six domains were chosen because they represent especially promising areas for investigation based on existing evidence and data. We believe that the project, and the broader agenda it seeks to advance, requires the involvement of scientists from a diverse set of disciplines, all of which have contributed to prior research in this area. Therefore, five of the six policy domains are represented by two papers each, typically one paper authored by economists or policy researchers, and the other by social epidemiologists. For some individual chapters, the team of authors includes scholars from these and other backgrounds. Moreover, we ourselves come from diverse disciplines which have played central roles in this emerging research area, including economics, epidemiology, public health, public policy, and sociology. Disciplines represented by other chapter au- / xi thors and discussants include child and human development, medicine, psychology , social work, and statistics. The project team first met in Ann Arbor in October 2004, where initial outlines of chapters were shared among all authors. David Mechanic, Chris Paxson, and Len Syme each provided a broad critical perspective on the project as well as detailed comments on the individual chapter outlines. Based on discussions at the first meeting, the editors agreed on the set of papers that would be presented at the final conference, “Health Effects of Non-health Policies,” which was held in February 2006 in Washington, D.C. The versions of the chapters presented at the final conference are available at the National Poverty Center website. At the conference, each chapter was discussed by two experts in the field: one representing the policy and economic perspective, and one representing the social epidemiologic perspective. The authors and editors benefited greatly from the insights of the chapter discussants: Lisa Berkman, Rebecca Blank, Ray Catalano, Doug Elmendorf, Harry Holzer, Christopher Jencks, Thomas Kane, Kim Lochner, Doug Miller, Katherine Newman, Narayan Sastry, and David Williams. During the last session of the conference, David Mechanic, Harold Pollack, and Len Syme provided a broad perspective on the research effort which heavily influenced the introduction and the conclusion to the book. Two anonymous reviewers of the initial book manuscript provided valuable feedback that improved every chapter, as did the editorial work of Suzanne Nichols of the Russell Sage Foundation. For most of the project, Laura Lee provided very able and energetic administrative support, as did Sarah Marsh at the end; and Cathy Doherty and Patricia Rayl assisted at several important points. The entire project, including the conferences and the book production, was supported by the Assistant Secretary for Planning and Evaluation of the U.S. Department of Health and Human Services through the National Poverty Center at the University of Michigan, the Russell Sage Foundation, the Robert Wood Johnson Foundation, and the Annie E. Casey Foundation. James Knickman and Michael McGinnis of the Robert Wood Johnson Foundation, Mike Laracy of the Annie E. Casey Foundation, and Eric Wanner of the Russell Sage Foundation each lent important support at critical points. Finally, Becky Blank and Sheldon Danziger initially proposed that the National Poverty Center sponsor our enterprise, and they both, but especially Sheldon, provided constant support and...