Access is critical but by itself not sufficient

Gary Parker, associate dean for external affairs and director of the Clark-Fox Policy Institute in the Brown School, and Dan Ferris, assistant dean for policy initiatives and director of policy and planning for the Brown School’s Envolve Center for Health Behavior Change


The Affordable Care Act is credited with expanding healthcare coverage to more than 20 million previously-uninsured Americans – a significant achievement for the United States as access to healthcare is a major driver of health outcomes.

Still, access alone will not eliminate racial health disparities, ranging from increased infant mortality rates to decreased life expectancy. Notably, the United Kingdom, which has a healthcare system built around universal coverage, also faces disparities by both race and ethnicity. This then begs the question, beyond access, what else must be done?

To start, a better understanding of the ways in which poverty diminishes physical and mental health is still urgently needed. Since poverty disproportionately impacts communities of color, in order to improve outcomes and advance health equity, it is critical to address the root causes of multi-generational poverty.

It makes intuitive sense. Of course the conditions in which we live, work, and play greatly impact our health and well-being. Housing, education, employment, transportation, safety, and access to services — sometimes referred to as social determinants of health — are increasingly recognized by researchers and policymakers as the missing pieces to the healthcare puzzle. According to the Centers for Disease Control and Prevention (CDC), 75 percent of population health is attributable to a combination of social factors, environment, and health and medical services.

So it should come as no surprise that multi-generational poverty also turns out to be a powerful social determinant of health, one that compounds ever-growing health inequities. According to the World Health Organization, the lower one’s socioeconomic status, the higher one’s risk for negative health outcomes. Poverty-impacted populations deserve high-quality physical and mental healthcare, but poverty and racial segregation leave many without sufficient resources and support.

The consequences can be fatal. Research conducted at the Brown School at Washington University in St. Louis — led by Jason Purnell and “For the Sake of All” — established the significant impact that neighborhood conditions have on life expectancies. For example, the difference in life expectancy between two ZIP codes in the same region, 63105 and 63106, can be as much as 18-years.

Turning their findings into action, Purnell and “For the Sake of All” are now leading a $1.1 million Robert Wood Johnson Foundation grant designed to promote healthy school environments, including a pilot program in St. Louis Public schools that aims to address student physical and emotional well-being by improving access to healthcare professionals through on-site clinics.

Meeting student health needs will better support their academic success and increase their long-term economic prospects. With innovative programs and policies leading to increased access, it’s now up to us at all levels – from school district and neighborhood to city and state leaders – to complete the puzzle with significant advancements across the social and environmental factors that have led to dramatic disparities such as life expectancy.

On April 5, the Brown School will host “Toward Healing and Health — Advancing Equity in Healthcare.” The event, free and open to the public, will feature Louis W. Sullivan, MD, former Secretary of the U.S. Department of Health and Human Services under President George H.W. Bush, founding dean and President Emeritus of Morehouse School of Medicine, and CEO and Chairman of the Sullivan Alliance.

Presented as the school’s annual Youngdahl Lecture, the discussion will explore how government, researchers, communities, and other stakeholders can work together to close systemic health gaps and support individuals and communities.

Solving the challenge of improving individual and community health — among the greatest of our time —will require engagement, collaboration, and dedicated advocacy. To overcome economic and racial inequities as powerful social determinants that drive health, we must address poverty by fixing the systems and structures that perpetuate it.

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