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Social science and health
The Social Science Journal 50 (2013) 405–407
Contents lists available at ScienceDirect
The Social Science Journal journal homepage: www.elsevier.com/locate/soscij
Editorial
Social science and health
Few areas in academic research receive as much attention as health and its corollaries, and the Social Science Journal is devoting this special issue to the interaction between health and the social sciences. Since the 1840s, life expectancy in now developed countries has increased by 2.5 years every decade, and there is no sign the linear increase in life expectancy has to stop. Until the 1960s, increases in life expectancy and other health outcomes primarily came from better nutrition and improved public sanitation. Medical intervention, when it was applied, frequently did more harm than good. However, somewhere during the 1960s, improvements in life expectancy switched from coming from in better nutrition and cleaner environments to medical intervention, and today, among these three, the majority of increased life expectancy and better health outcomes is from medical intervention. Nevertheless, life expectancy in developing countries continues to increase from better nutrition and improved sanitation conditions. Many of the health improvements, therefore, deal with microbiology, medicine, and pharmaceuticals, and today is an exciting time to study and practice in health related fields. Nevertheless, the social sciences have an important contribution to make in increasing life expectancy and improving health outcomes. From health economics and political science to sociology and public policy, the social sciences illustrate the role of markets in allocating health resources and inform policy makers in ways that are beyond other disciplines. In 2009, the United States spent nearly 2.5 trillion dollars on health care, which was 4% more than 2008. For a sense of perspective, greater percentage increases occurred in the 1970s and 1980s. The U.S. also devoted a greater share of its Gross Domestic Product to health care than other countries. In 2009, 17.6% of U.S. GDP was devoted to healthcare, while the next largest healthcare shares among developed countries were 11.9% for France and 11.7% for Germany. In 2000, the World Health Report was published, which highlighted that for all its resources devoted to healthcare, the U.S. ranked near the bottom on many health outcomes, such as life expectancy at birth and
infant mortality rates (Atlas, 2011). Moreover, the percent of state populations covered with health insurance within the U.S. varies widely, where states such as Nevada, New Mexico, and Texas have over 20% of their populations without insurance, whereas states such as Connecticut, Hawaii, and Massachusetts have less than 10% of their populations that do not have insurance. One conclusion is that national resources devoted to health care vary both within countries and internationally. The job of the social sciences is to understand why these patterns exist. Are they due to personal choices or structural inequalities that foreclose significant shares of national populations from access to healthcare? Primary economic concerns with healthcare provision are costs, access, and technological development. Between 1970 and 2009, the price of healthcare increased by over 1,000%, while the price of all other goods increased by only 450%. Such disparity in price increases indicates that access to healthcare is limited, and individuals in lower socioeconomic groups are now more foreclosed from health than at any time in history. However, such an interpretation overlooks the tremendous improvement in health outcomes since the 1970s. For example, in 1970 life expectancy for both males and females was around 73 years. By 2010, life expectancy had increased to 79 years. The increase in life expectancy also indicates nothing about the change in the quality of life during these additional six years. Increased access to for all socioeconomic groups is a priority for healthcare professionals. The number of people, both voluntarily and involuntarily, without health insurance has increased from 14.5% in 1984 to 18.2% in 2010. This decrease in the portion of the public covered by insurance, however, does not correspond to an equal decrease in the share of the public with access to healthcare, and the Emergency Medical Treatment and Active Labor Act of 1986 made it illegal to refuse life-saving treatment to a patient in need at a hospital emergency room, regardless of a patient’s ability to pay. An easy trade-off to overlook in the cost-access dilemma is the change in life saving technologies that have increased both longevity and the quality of life. The four leading
0362-3319/$ – see front matter © 2013 Western Social Science Association. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.soscij.2013.10.004
406
Editorial / The Social Science Journal 50 (2013) 405–407
causes of death in the U.S. are heart disease, cancer, chronic lower respiratory diseases, and stroke, and for each of these mortalities, the medical intervention in the U.S. is changing life expectancy and the quality of life for persons in the U.S. around the World. In 1948, the Framingham Massachusetts Heart Study set out to find the leading conditions and behaviors associated with cardiovascular disease by statistically linking individuals and families over several decades to determine what are the primary risk factors associated with heart disease. The results have been astounding, and we now know many of the primary conditions and behaviors associated with heart disease. In the case of cancer, 80% of all new cancer drugs now are first produced and marketed by firms in the U.S. Spillover treatments then proliferate internationally. Stroke is another leading mortality, but here too, U.S. deaths from stroke are retreating at a faster pace than other developed countries. Improvements in heart disease, cancer, and stroke result from unique combinations between private and public enterprises. For example, in 1981, the Bayh–Dole Act gave public institutions—such as university research centers, small businesses, or nonprofit organizations—the right to royalties from health technologies created with their equipment from federally funded projects. This gives universities greater incentives to promote health research because they are able to claim royalties from the lifesaving technologies developed at their institutions. These incentives to public institutions are important for health research because more resources within private sector drug companies now go toward marketing and advertising than devoted to research and development. The legislative result is that medical development in the U.S. has a unique relationship between public and private sectors and is an important source of health improving technologies that improve international health related living standards and increase life expectancy. A heavily partisan national debate continues in the U.S. regarding the 2010 Affordable Care Act (ACA), with a particular focus on individual rights and taxation as they relate to health insurance. Much less often does debate center on whether the ACA will reduce existing health disparities in the United States or if it will improve U.S. health outcomes relative to other countries. The World Health Organization (WHO) in 2011 lists 32 countries with life expectancy above the U.S. life expectancy of 79 years, four years behind the top countries of Japan, San Marino, and Switzerland (World Health Organization, 2013). More problematic are the wide disparities in life expectancy and health outcomes that persist within the U.S. by race/ethnicity, socioeconomic status, and gender (Case & Paxson, 2005; House, 2002; Link & Phelan, 1995; Rogers, Everett, Saint Onge, & Krueger, 2010; Williams & Collins, 1995). These disparities are particularly relevant given evidence that life expectancy dropped in some U.S. counties between 1961 and 1999 in spite of the overall increase at the national level (Ezzati, Friedman, Kulkarni, & Murray, 2008). Sociological health research aims to understand how these social characteristics and other demographic, behavioral, and environmental factors are related with health profiles of individuals and groups.
Therefore, whereas the ACA remains a relevant topic in health disparities discourse, health care accessibility, and the provision of health insurance cannot be expected to remedy the wide array of persistent health disparities in the U.S. (Atlas, 2011). A foundational work framing social health research for the past two decades is Link and Phelan’s “Social Conditions as Fundamental Causes of Disease” (1995). This work frames how underlying social factors, termed fundamental causes, provide a context within which individual health behaviors and other proximate causes of illness function. Access to health care remains only a small piece of this story, as the quality of health care that one has access to may be just as important (Lutfey & Freese, 2005). Lost in the debate over funding the ACA are discussions about the quality and continuity of care. Subsequent work following Link and Phelan (1995) explores the various proximate pathways through which fundamental social causes function. Health behaviors research examines SES differences in smoking, exercise, and diet and addresses the mechanisms that lead to the broad spectrum of health outcomes by SES (Pampel, Krueger, & Denney, 2010). Researchers now recognize that health statuses are not linked to behaviors or risk factors at a single point in time. Rather, one’s life experiences and social circumstances cumulatively throughout life may impact health and mortality risk later in life (Ferraro & Kelley-Moore, 2003; Haas, 2007; Hayward & Gorman, 2004). Health research continues to expand in new directions to address the needs of a diverse and growing world population. Continued innovation is essential to the field as new problems emerge and as our understanding of health inequalities changes over time. In the pages that follow, studies in this issue explore some of the most important relationships between the social sciences and health. We begin by considering the economics and public policy of health care. Behavior, mass communication, and health marketing are subtle but increasingly important aspects of the relationship between health and the social sciences. Our discussion extends further into sexuality, abortion, and health, followed by examination of issues relating to obesity and nutrition. We finish the issue by considering how the relationship between health and the social sciences extends across international boundaries and is, therefore, common to all social and economic systems. Nevertheless, this Special Issue is a continuation of the Social Science Journal’s role in health and social interaction and is a beginning and continuation rather than a conclusion.
References Atlas, S. (2011). In Excellent health: Setting the record straight on America’s Health Care. Stanford, CA: Hoover Institution Press. Case, A., & Paxson, C. (2005). Sex differences in morbidity and mortality. Demography, 42(2), 189–214. Ezzati, M., Friedman, A. B., Kulkarni, S. C., & Murray, C. J. L. (2008). The reversal of fortunes: Trends in county mortality and cross-county mortality disparities in the United States. PLoS Medicine, 5, 0557–0568. Ferraro, K. F., & Kelley-Moore, J. A. (2003). Cumulative disadvantage and health: Long-term consequences of obesity? American Sociological Review, 68, 707–729.
Editorial / The Social Science Journal 50 (2013) 405–407 Haas, S. A. (2007). The long-term effects of poor childhood health: An assessment and application of retrospective reports. Demography, 44, 113–135. Hayward, M. D., & Gorman, B. K. (2004). The long arm of childhood: The influence of early life social conditions on men’s mortality. Demography, 41(1), 87–107. House, J. S. (2002). Understanding social factors and inequalities in health: 20th century progress and 21st century prospects. Journal of Health and Social Behavior, 43, 125–142. Link, B. G., & Phelan, J. C. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, 80–94 (Extra issue). Lutfey, K., & Freese, J. (2005). Toward some fundamentals of fundamental causality: Socioeconomic stats and health in the routine clinic visit for diabetes. American Journal of Sociology, 110, 1326–1372. Pampel, F. C., Krueger, P. M., & Denney, J. T. (2010). Socioeconomic disparities in health behaviors. Annual Review of Sociology, 36, 349–370. Rogers, R. G., Everett, B. G., Saint Onge, J. M., & Krueger, P. M. (2010). Social, behavioral, and biological factors, and sex differences in mortality. Demography, 47, 555–578. Williams, D. R., & Collins, C. (1995). U.S. socioeconomic and racial differences in health: Patterns and explanations. Annual Review of Sociology, 21, 349–386.
407
World Health Organization. (2013). Life expectancy at birth. Both sexes: 2011. www.who.int. Retrieved from http://gamapserver.who. int/gho/interactive charts/mbd/life expectancy/atlas.html
Scott Alan Carson ∗ Jeff Dennis University of Texas, Permian Basin, 4901 East University, Odessa, TX 79762, USA ∗ Corresponding author. E-mail address: carson [email protected] (S.A. Carson)
4 October 2013 4 October 2013 Available online 4 November 2013
Contents lists available at ScienceDirect
The Social Science Journal journal homepage: www.elsevier.com/locate/soscij
Editorial
Social science and health
Few areas in academic research receive as much attention as health and its corollaries, and the Social Science Journal is devoting this special issue to the interaction between health and the social sciences. Since the 1840s, life expectancy in now developed countries has increased by 2.5 years every decade, and there is no sign the linear increase in life expectancy has to stop. Until the 1960s, increases in life expectancy and other health outcomes primarily came from better nutrition and improved public sanitation. Medical intervention, when it was applied, frequently did more harm than good. However, somewhere during the 1960s, improvements in life expectancy switched from coming from in better nutrition and cleaner environments to medical intervention, and today, among these three, the majority of increased life expectancy and better health outcomes is from medical intervention. Nevertheless, life expectancy in developing countries continues to increase from better nutrition and improved sanitation conditions. Many of the health improvements, therefore, deal with microbiology, medicine, and pharmaceuticals, and today is an exciting time to study and practice in health related fields. Nevertheless, the social sciences have an important contribution to make in increasing life expectancy and improving health outcomes. From health economics and political science to sociology and public policy, the social sciences illustrate the role of markets in allocating health resources and inform policy makers in ways that are beyond other disciplines. In 2009, the United States spent nearly 2.5 trillion dollars on health care, which was 4% more than 2008. For a sense of perspective, greater percentage increases occurred in the 1970s and 1980s. The U.S. also devoted a greater share of its Gross Domestic Product to health care than other countries. In 2009, 17.6% of U.S. GDP was devoted to healthcare, while the next largest healthcare shares among developed countries were 11.9% for France and 11.7% for Germany. In 2000, the World Health Report was published, which highlighted that for all its resources devoted to healthcare, the U.S. ranked near the bottom on many health outcomes, such as life expectancy at birth and
infant mortality rates (Atlas, 2011). Moreover, the percent of state populations covered with health insurance within the U.S. varies widely, where states such as Nevada, New Mexico, and Texas have over 20% of their populations without insurance, whereas states such as Connecticut, Hawaii, and Massachusetts have less than 10% of their populations that do not have insurance. One conclusion is that national resources devoted to health care vary both within countries and internationally. The job of the social sciences is to understand why these patterns exist. Are they due to personal choices or structural inequalities that foreclose significant shares of national populations from access to healthcare? Primary economic concerns with healthcare provision are costs, access, and technological development. Between 1970 and 2009, the price of healthcare increased by over 1,000%, while the price of all other goods increased by only 450%. Such disparity in price increases indicates that access to healthcare is limited, and individuals in lower socioeconomic groups are now more foreclosed from health than at any time in history. However, such an interpretation overlooks the tremendous improvement in health outcomes since the 1970s. For example, in 1970 life expectancy for both males and females was around 73 years. By 2010, life expectancy had increased to 79 years. The increase in life expectancy also indicates nothing about the change in the quality of life during these additional six years. Increased access to for all socioeconomic groups is a priority for healthcare professionals. The number of people, both voluntarily and involuntarily, without health insurance has increased from 14.5% in 1984 to 18.2% in 2010. This decrease in the portion of the public covered by insurance, however, does not correspond to an equal decrease in the share of the public with access to healthcare, and the Emergency Medical Treatment and Active Labor Act of 1986 made it illegal to refuse life-saving treatment to a patient in need at a hospital emergency room, regardless of a patient’s ability to pay. An easy trade-off to overlook in the cost-access dilemma is the change in life saving technologies that have increased both longevity and the quality of life. The four leading
0362-3319/$ – see front matter © 2013 Western Social Science Association. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.soscij.2013.10.004
406
Editorial / The Social Science Journal 50 (2013) 405–407
causes of death in the U.S. are heart disease, cancer, chronic lower respiratory diseases, and stroke, and for each of these mortalities, the medical intervention in the U.S. is changing life expectancy and the quality of life for persons in the U.S. around the World. In 1948, the Framingham Massachusetts Heart Study set out to find the leading conditions and behaviors associated with cardiovascular disease by statistically linking individuals and families over several decades to determine what are the primary risk factors associated with heart disease. The results have been astounding, and we now know many of the primary conditions and behaviors associated with heart disease. In the case of cancer, 80% of all new cancer drugs now are first produced and marketed by firms in the U.S. Spillover treatments then proliferate internationally. Stroke is another leading mortality, but here too, U.S. deaths from stroke are retreating at a faster pace than other developed countries. Improvements in heart disease, cancer, and stroke result from unique combinations between private and public enterprises. For example, in 1981, the Bayh–Dole Act gave public institutions—such as university research centers, small businesses, or nonprofit organizations—the right to royalties from health technologies created with their equipment from federally funded projects. This gives universities greater incentives to promote health research because they are able to claim royalties from the lifesaving technologies developed at their institutions. These incentives to public institutions are important for health research because more resources within private sector drug companies now go toward marketing and advertising than devoted to research and development. The legislative result is that medical development in the U.S. has a unique relationship between public and private sectors and is an important source of health improving technologies that improve international health related living standards and increase life expectancy. A heavily partisan national debate continues in the U.S. regarding the 2010 Affordable Care Act (ACA), with a particular focus on individual rights and taxation as they relate to health insurance. Much less often does debate center on whether the ACA will reduce existing health disparities in the United States or if it will improve U.S. health outcomes relative to other countries. The World Health Organization (WHO) in 2011 lists 32 countries with life expectancy above the U.S. life expectancy of 79 years, four years behind the top countries of Japan, San Marino, and Switzerland (World Health Organization, 2013). More problematic are the wide disparities in life expectancy and health outcomes that persist within the U.S. by race/ethnicity, socioeconomic status, and gender (Case & Paxson, 2005; House, 2002; Link & Phelan, 1995; Rogers, Everett, Saint Onge, & Krueger, 2010; Williams & Collins, 1995). These disparities are particularly relevant given evidence that life expectancy dropped in some U.S. counties between 1961 and 1999 in spite of the overall increase at the national level (Ezzati, Friedman, Kulkarni, & Murray, 2008). Sociological health research aims to understand how these social characteristics and other demographic, behavioral, and environmental factors are related with health profiles of individuals and groups.
Therefore, whereas the ACA remains a relevant topic in health disparities discourse, health care accessibility, and the provision of health insurance cannot be expected to remedy the wide array of persistent health disparities in the U.S. (Atlas, 2011). A foundational work framing social health research for the past two decades is Link and Phelan’s “Social Conditions as Fundamental Causes of Disease” (1995). This work frames how underlying social factors, termed fundamental causes, provide a context within which individual health behaviors and other proximate causes of illness function. Access to health care remains only a small piece of this story, as the quality of health care that one has access to may be just as important (Lutfey & Freese, 2005). Lost in the debate over funding the ACA are discussions about the quality and continuity of care. Subsequent work following Link and Phelan (1995) explores the various proximate pathways through which fundamental social causes function. Health behaviors research examines SES differences in smoking, exercise, and diet and addresses the mechanisms that lead to the broad spectrum of health outcomes by SES (Pampel, Krueger, & Denney, 2010). Researchers now recognize that health statuses are not linked to behaviors or risk factors at a single point in time. Rather, one’s life experiences and social circumstances cumulatively throughout life may impact health and mortality risk later in life (Ferraro & Kelley-Moore, 2003; Haas, 2007; Hayward & Gorman, 2004). Health research continues to expand in new directions to address the needs of a diverse and growing world population. Continued innovation is essential to the field as new problems emerge and as our understanding of health inequalities changes over time. In the pages that follow, studies in this issue explore some of the most important relationships between the social sciences and health. We begin by considering the economics and public policy of health care. Behavior, mass communication, and health marketing are subtle but increasingly important aspects of the relationship between health and the social sciences. Our discussion extends further into sexuality, abortion, and health, followed by examination of issues relating to obesity and nutrition. We finish the issue by considering how the relationship between health and the social sciences extends across international boundaries and is, therefore, common to all social and economic systems. Nevertheless, this Special Issue is a continuation of the Social Science Journal’s role in health and social interaction and is a beginning and continuation rather than a conclusion.
References Atlas, S. (2011). In Excellent health: Setting the record straight on America’s Health Care. Stanford, CA: Hoover Institution Press. Case, A., & Paxson, C. (2005). Sex differences in morbidity and mortality. Demography, 42(2), 189–214. Ezzati, M., Friedman, A. B., Kulkarni, S. C., & Murray, C. J. L. (2008). The reversal of fortunes: Trends in county mortality and cross-county mortality disparities in the United States. PLoS Medicine, 5, 0557–0568. Ferraro, K. F., & Kelley-Moore, J. A. (2003). Cumulative disadvantage and health: Long-term consequences of obesity? American Sociological Review, 68, 707–729.
Editorial / The Social Science Journal 50 (2013) 405–407 Haas, S. A. (2007). The long-term effects of poor childhood health: An assessment and application of retrospective reports. Demography, 44, 113–135. Hayward, M. D., & Gorman, B. K. (2004). The long arm of childhood: The influence of early life social conditions on men’s mortality. Demography, 41(1), 87–107. House, J. S. (2002). Understanding social factors and inequalities in health: 20th century progress and 21st century prospects. Journal of Health and Social Behavior, 43, 125–142. Link, B. G., & Phelan, J. C. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, 80–94 (Extra issue). Lutfey, K., & Freese, J. (2005). Toward some fundamentals of fundamental causality: Socioeconomic stats and health in the routine clinic visit for diabetes. American Journal of Sociology, 110, 1326–1372. Pampel, F. C., Krueger, P. M., & Denney, J. T. (2010). Socioeconomic disparities in health behaviors. Annual Review of Sociology, 36, 349–370. Rogers, R. G., Everett, B. G., Saint Onge, J. M., & Krueger, P. M. (2010). Social, behavioral, and biological factors, and sex differences in mortality. Demography, 47, 555–578. Williams, D. R., & Collins, C. (1995). U.S. socioeconomic and racial differences in health: Patterns and explanations. Annual Review of Sociology, 21, 349–386.
407
World Health Organization. (2013). Life expectancy at birth. Both sexes: 2011. www.who.int. Retrieved from http://gamapserver.who. int/gho/interactive charts/mbd/life expectancy/atlas.html
Scott Alan Carson ∗ Jeff Dennis University of Texas, Permian Basin, 4901 East University, Odessa, TX 79762, USA ∗ Corresponding author. E-mail address: carson [email protected] (S.A. Carson)
4 October 2013 4 October 2013 Available online 4 November 2013