The United States has long struggled to expand access to high quality health care to all its people, yet the health of the poor and the working-class is also tied to social factors such as where they live, their income, and their relationships. In today’s Working-Class Perspectives post, community psychiatrist Kenneth Thompson argues that in order to improve the health of poor and working-class communities, we must connect health care with social policy.

For a long time and to this day, this has been the American approach to health care, though the ACA does a bit to address it.  Given this, some Americans may assume that the recent increase in mortality among white folks reflects a lack of access to needed care. The work of two other Brits, Thomas McKeown and Michael Marmot reveals the inadequacy of this belief.  McKeown made the trenchant observation that it wasn’t health care that made people healthy, but rather the conditions in which they lived. Marmot pressed this observation and, in a series of famous studies of civil servants in the British Government, found that health status was tied in a step-wise fashion with class.  Poor working-class people had worse health then their middle-class colleagues who in turn were less healthy than the highly paid executives.  These findings created a fire storm around the world, but some thirty years later, the idea has finally begun to find its way to the US in the form a focus on the “social determinants of health.” Where people live, their income, the resources available to them, the web of social relationships they experience, all come under this rubric. Health isn’t just about people’s lifestyle — whether they smoke or drink — or about their access to health care. It is fundamentally about the kinds of lives people live and how they are socially structured. Health is profoundly ecological– it reflects the social habitat and physical environment people live in.

Take a moment to read the post in its entirety and check out other Working-Class Perspectives posts on our website.