Healthcare is one of several factors that affect longevity in the United States, a new study reaffirms. Behavioral and social factors have much more influence. Robert Kaplan, PhD, and Arnold Milstein, MD, MPH, from Stanford University School of Medicine’s Clinical Excellence Research Center in California, test how much healthcare affects the risk for premature death using four different research methods and data sets.

All four methods yield the same conclusion; Healthcare accounts for between 5% and 15% (roughly 10%) of variation in premature death; so whereas behavioral and social factors account for 16% to 65%. The authors suggest that current healthcare policy; also spending in the United States are misguide because they’re base on the assumption; so that focusing heavily on medical care is the key to improving outcomes and boosting longevity.

Medical care contributes

A lot of the modeling analyses make the assumption that essentially 100% of the life expectancy; hence is relate to access to medical care. “Even the most sophisticate modeling analyses make assumptions; so like at least half of the variability in life expectancy is medical care related. The 10% that medical care contributes to longevity is important; so Kaplan emphasize, and the results do not suggest the United States should not invest in medical care.

“But if our goal is to have longer, healthier lives, they have to go beyond traditional medicine; because most of what determines life expectancy is outside the healthcare system,” he said. Joshua Sharfstein, MD, vice dean for public policy at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, agrees with Kaplan and Milstein that the popular perception is that healthcare is everything and that the US underinvests in things that could produce important results.

Other countries have a much stronger safety net,” Sharfstein said. They shouldn’t be surprise that their health outcomes are better and their life expectancies are longer.” Sharfstein said changing the direction on healthcare policy has to start with changing the conversation.

Health cannot depend

He points out that better health cannot depend on any one sector; so because the sectors are interconnect: people cannot access jobs or health care; hence for example, without stable housing, transportation, and child care. Reversing the trend of spending only 55 cents on the dollar for non medical services is unlikely in the current climate in Washington, DC, and in many states, so change is more likely to occur at the local level, Woolf writes.

If a clinician knows that a patient can’t read English or can’t afford medications, for instance, the clinician can help find a translator or suggest less expensive medications, he explains. Physicians and nurses can also use their trust voice in the community to advocate for investment in education or public transportation or for livable wages, and they can join professional societies that are taking stances on social change.

Woolf writes that an example of the misalignment of values with current healthcare policy and spending is exemplify in a quote by organizers of the 2017 Medicalization of Poverty Symposium: “We spend inordinate amounts of money and other resources to address healthcare needs brought on by poverty instead of providing for the tangible needs of the poor before illness strikes.