Poor people are more likely to have health problems starting at birth and to die younger than rich people. This stark inequality is firmly established, but the underlying causes and their relative contributions are not well understood.
A new Stanford study investigated whether unequal access to informal health expertise contributes to this problem. Specifically, they explored whether having a physician or nurse in your family improves your health.
The multidisciplinary team analyzed public records for Swedish residents, including socioeconomic, health care, educational and birth records. Despite Sweden’s universal health insurance system and generous social safety net, they found that health inequality still emerged early in life and persisted throughout adulthood — at levels comparable with the United States.
“This health inequity appears to be extremely stubborn,” said Petra Persson, PhD, an assistant professor of economics, in a Stanford News article. “We can throw a universal health insurance system at it and yet substantial inequality persists. So, is there anything else that can help us close that health gap between rich and poor?”
Diving deeper, the researchers divided the Swedish individuals into two groups — those with or without medical professionals in their immediate or extended families.
The team discovered that having medical expertise available from a family member led to far-reaching health improvements at all ages. Those individuals lived longer, were significantly healthier, were more likely to engage in preventive health behaviors and were more likely to adhere to medications. For example, the older relatives of medical professionals were 27 percent more likely to adhere to medications to prevent heart attacks and the younger relatives were 20 percent more likely to be vaccinated against human papillomavirus, their paper reported.
These trends extended across all incomes, but they were even more pronounced in low-income families. This implies, according to the researchers, that the scarcity of access to medical expertise in low-income households could create and sustain inequality in health outcomes.
However, this may point to new ways to tackle the health disparity. The authors concluded in the paper, “Our analysis suggests that access to expertise improves health not through preferential treatment, but rather through intra-family transmission of ‘low-tech’ (and hence, cheap) determinants of health, likely ranging from the sharing of nuanced knowledge about healthy behaviors, to reminders about adherence to chronic medication, to frequent and trustful communication about existing health."
Persson added in the piece, “If the government and health care system, including public and private insurers, could mimic what goes on inside families, then we could reduce health inequity by as much as 18 percent.”
A key solution may be in creating a closer, longer-term relationship between patients and their doctors, the authors said. But they also warned that the U.S. appears to be moving away from this “old-fashioned” primary care model — a shift in the wrong direction according to their results.
Photo by Kevin Curtis