Thomas Ramey Watson

The Root Causes Behind Many Health Problems May Surprise You

From her office in the peaceful and picturesque Laurel Heights neighborhood, Paula Braveman directs the Center on Social Disparities in Health at the University of California (San Francisco) and writes prolifically on the links between class, race, and health. She spoke recently to National Journal about the complex relationships among opportunity, biology, personal responsibility, and the way Americans live and die. Edited excerpts follow.

A lot of people are not familiar with the phrase “social determinants of health.” What do you mean by that?

We mean the factors apart from medical care that have a powerful influence on health.

In assessing America’s overall health, how important are the social determinants, such as poverty and disparities in income and education, versus medical care?

There are people who [conclude] about 10 percent of premature mortality is due to lack of access and/or deficiencies in medical care. If I had to guess, I’d say maybe 20 percent [is medical care].

That would mean roughly 80 percent of premature mortality is related to the social determinants?

Once you’re sick, you want medical care. But what is it that shapes whether you get sick and how sick you get? It’s the circumstances into which you were born, you grow up, you live, you work.


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