文章基本信息

标题：US Opinions on Health Determinants and Social Policy as Health Policy
本地全文：下载
作者：Stephanie A. Robert ; Bridget C. Booske
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2011
卷号：101
期号：9
页码：1655-1663
DOI：10.2105/AJPH.2011.300217
语种：English
出版社：American Public Health Association
摘要：To examine what factors the public thinks are important determinants of health and whether social policy is viewed as health policy, we conducted a national telephone survey of 2791 US adults from November 2008 through February 2009. Respondents said that health behaviors and access to health care have very strong effects on health; they were less likely to report a very strong role for other social and economic factors. Respondents who recognized a stronger role for social determinants of health and who saw social policy as health policy were more likely to be older, women, non-White, and liberal, and to have less education, lower income, and fair/poor health. Increasing public knowledge about social determinants of health and mobilizing less advantaged groups may be useful in addressing broad determinants of health. Increasing attention is being paid to research demonstrating that, in addition to access to medical care, a broad array of social, political, and economic factors affect health. There is evidence that a person's health behaviors (e.g., exercise, diet, smoking), psychosocial stressors and resources, and socioeconomic status (e.g., education, income, wealth, occupational prestige) all affect health. Moreover, the social, economic, environmental, and political conditions in which people live, work, and play affect people's ability to make healthy behavior choices and shape their psychosocial stressors and resources.^{1 – 5} Some experts suggest that improving early childhood development, educational attainment and quality, and poverty and economic attainment might be just as important to improving health and reducing health disparities as improving access to health care (if not more important).^{6 – 14} In fact, efforts in many countries, including significant efforts in the United Kingdom, Sweden, Canada, and the Netherlands, have begun to advance social and economic policy agendas as a means to improve health.^{15 – 18} However, in the United States there has been less public discourse about how to improve health by advancing social and economic policy.^{19 , 20} Most health discourse and media attention in the United States have focused on improving access to health insurance and health care and on individual health behaviors such as diet, exercise, and smoking.^{21 – 25} However, some recent US initiatives have attempted to broaden the health discourse to consider the wide array of factors that affect health. For example, the 7-part video series Unnatural Causes highlighted the nonmedical determinants of health.²⁶ In addition, the Robert Wood Johnson Foundation established the Commission to Build a Healthier America, whose work highlighted the nonmedical interventions and policies that are necessary to promote health.^{4 , 14} More recently, the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute produced the first set of county-specific health rankings within each of the 50 states.²⁷ These rankings are based on a broad model of population health addressing the multiple factors that affect health (health behaviors, clinical care, social and economic factors, and the environment). It is not yet clear how these and other recent efforts will change the health discourse in the United States, particularly as health care reform implementation continues to take center stage. We do not know what the general US public thinks about the broad determinants of health and about the potential role of social and economic policy in improving health. In the United States, public opinion surveys about health have generally focused on opinions about health care or on public health prevention services but not on people's beliefs about a broad range of determinants of health and health disparities.^{28 – 31} Surveys in other countries have examined public opinion on a broad range of determinants of health, and a US survey on this topic was conducted among Wisconsin residents.^{32 – 36} US public opinion research also has not examined the range of strategies—excepting improved access to health care or health insurance—that the public believes would be effective at improving health. The public's opinions about the nonmedical determinants of health and their level of support for social and economic policies to improve health are likely to influence policymakers’ willingness to address social and economic policy as health policy.^{37 – 39} We conducted the National Opinion Survey on Health and Health Disparities to better understand US public opinion regarding the determinants of health and health disparities and the policies relevant to improving health and reducing health disparities. We also examined whether opinions differed depending on respondents’ education level, income, race/ethnicity, political views, age, gender, and self-rated health status.