International study finds health inequities are about more than health coverage; editorial explores implications for US Presidential elections

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A new study published today in JAMA compares health inequities across 22 European countries. Not surprisingly, rates of death and poor health are linked to lower socioeconomic status. However the scale of the disparity varied widely between countries. The authors attribute the variations in part to causes of death due to smoking, alcohol use and access to good quality health care. Interestingly, the variation between countries did not track with the generosity of welfare policies. Southern European countries tend to have less generous and less universal policies than Northern countries, but smaller health inequities, possibly due to healthier diets and lower smoking rates among women. The authors conclude that, while “a reasonable level of social security and public services may be a necessary condition for smaller inequities in health, it is not sufficient.” They suggest that improving educational opportunities, income distribution, healthy behaviors and access to quality health care may be most important. The accompanying editorial links the study to our upcoming Presidential elections. Virtually all of the 22 countries in the study have national health care policies, but wide health inequities remain. “[P]olicies related to preventive social, economic and behavioral interventions might well have a greater effect on reducing disparities than traditional medical interventions, even if as an unintended by-product.” As we’ve hard from states that are implementing “universal” health care reforms, like MA, VT and ME — it’s not all about insurance.
Ellen Andrews