The Role of Economics in Addressing Health Disparities

🌍 Economic empowerment as a pathway to better mental health in the Global South 💡 Poverty and mental health are deeply intertwined – one reinforcing the other. In the Global South, where 74% of the world’s extreme poor live, innovative approaches are urgently needed to break this cycle. In our recent editorial in BJPsych Open, we highlight evidence that carefully designed economic empowerment programmes – such as cash transfers, microcredit, and productive asset transfers – can improve not only household finances but also mental health outcomes. One example is the Shamba Maisha intervention in Kenya, which combined microcredit for farming tools with agricultural and financial training. The results? ✔ Reduced parental stress and absenteeism ✔ Less harsh parenting ✔ Stronger caregiver–adolescent relationships ✔ Improved adolescent psychological well-being This growing body of research shows that intersectoral approaches—linking financial empowerment with health and education—have the potential to transform lives, influence both economic and health policy, and bring us closer to Universal Health Coverage. Monika Müller, MD-PhD; Soumitra Pathare (Centre for Mental Health Law & Policy, ILS, Pune); Abhijit Nadkarni (Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, U. of London; Sangath India) 📝 Read more in our open access editorial: https://lnkd.in/dFrmNnft

For those who care about health disparities research, I want to highlight an important and insightful article published yesterday by The New York Times on the Trump administration’s efforts to scrap research into health disparities arguing that spending billions on these initiatives is bad health policy. What is actually happening is that we spend far more money allowing these disparities to continue unabated, than we have been investing to understand the causes of these disparities and develop effective and tailored interventions. In a study that we led and published last year, conservatively estimating the projected costs of racial and ethnic disparities primarily focused on the most costly chronic diseases, including mental health, we found that in five years, by 2030, the United States is expected to spend $1 trillion owing to these health disparities if we don’t seriously study and address these issues. Health disparities research is critical because it illuminates the persistent and often preventable differences in health outcomes across populations. By identifying the factors driving these disparities, this research provides the evidence base necessary to design targeted and effective interventions that save lives and save money. These interventions, informed by rigorous data and community engagement, are already helping to close the gap by addressing root causes rather than symptoms. The New York Times highlighted several research studies that have led to eliminating disparities and elevating the health of all populations. In doing so, health disparities research is not only documenting inequities but actively driving solutions to create a more just and healthier society for all.

What would it mean for the economy to serve #HealthForAll and how can we get there? My piece in The Lancet with World Health Organization Director Dr Tedros Adhanom Ghebreyesus explores how to implement the WHO “Resolution on Economics of Health for All”, from valuing health in the economy to investing in public sector capacity. Read the full article ⬇️ https://lnkd.in/e37ubx7u Informed by the WHO Council on the Economics of Health for All, which I chaired alongside 10 other fantastic women economists, and the recommendations in our final report ⬇️  https://lnkd.in/ers_EdMa

Witnessing the profound impact of social and economic factors on health has reshaped my perspective on healthcare. Our well-being isn't just determined by what happens in clinics but by our access to food, housing, utilities, transportation, and safety. These factors can profoundly influence our lives, especially for those who are marginalized or economically disadvantaged. In the U.S., nearly two-thirds of primary care physicians screen patients for social needs, yet only about a third screen for financial security, a critical concern for many low-income Americans. This gap reveals a significant mismatch between what physicians are looking for and what patients are most worried about. Our current healthcare system is slowly recognizing the importance of addressing these drivers. Providers, payers, and policymakers are taking steps to integrate social and economic needs into clinical care. This includes screening patients for these needs and coordinating with community-based organizations to address them. However, this effort often requires resources that many practices lack, and some argue that addressing non-medical needs falls outside the traditional scope of healthcare. From my perspective, the evidence suggests that meeting these needs can reduce costly healthcare demands and improve outcomes. For example, food insecurity is linked to chronic conditions like diabetes and hypertension, which require ongoing management. By addressing such needs, we can potentially alleviate the burden on emergency and chronic care services. The Centers for Medicare and Medicaid Services (CMS) have facilitated these efforts by creating pathways to address social needs. Yet, many states, particularly in the Midwest and South, have yet to fully leverage these opportunities. Encouraging more states to participate through simplified application processes and clearer guidance could expand these beneficial programs nationwide., investingIn my work, I've seen the critical need for a healthcare system that addresses more than just clinical symptoms. By focusing on the social determinants of health, we can create a more holistic approach to patient care. This means not only screening for and addressing these needs, investing in community resources, and forming strong partnerships with local organizations. As we move forward, we must continue to advocate for policies and practices that integrate social and medical care. This approach will not only improve individual health outcomes and create a more equitable and efficient healthcare system for all. It's time to rethink how we deliver care in America, ensuring every patient has the support they need to live healthy, fulfilling lives. Read more at: https://buff.ly/4buJ798 #healthcare #hospitals #health #doctors

For most people, mental health challenges are not the problem but rather a consequence. Therefore, prevention happens through reducing preventable factors such as early life adversities, toxic stress, and social determinants like persistent economic hardship, discrimination, and place-based inequalities, not delivering after-the-fact clinical models. This perspective underscores the inseparability of the person from their family, community, and political context: upstream influences like these disrupt not only brain development—through altered neural circuits and stress hormone dysregulation—but also bodily systems, leading to intertwined issues such as depression, anxiety, self-harm, and co-occurring chronic diseases like inflammation-driven conditions or cardiovascular problems. Therefore, the most effective solution lies not in expanding mental health services but through preventive strategies like economic support, strengthening family integrity, and equitable policies that holistically support self-determination and invest in growing the capabilities and freedoms of people, neighborhoods, and communities.

🏥 NEW AHA SCIENTIFIC STATEMENT: Tackling the Root Causes of Obesity Disparities https://lnkd.in/ezsNB5Ac The obesity epidemic persists affecting >40% of US adults and 20% of children but the burden is NOT equally distributed. 📊 THE DISPARITIES ✅ 45% of adults with ≤high school education have obesity vs. 34% with advanced degrees ✅ Non-Hispanic Black children and adults face highest rates ✅ Annual US cost: >$1.4 trillion, compounded in underresourced communities 🔍 WHY INDIVIDUAL-FOCUSED INTERVENTIONS FAIL Programs prioritizing personal behaviors ignore upstream barriers: ∙ Weight stigma (affects healthcare seeking and activates stress pathways promoting adiposity) ∙ Provider implicit bias limiting diagnosis and care ∙ Built environment legacy of redlining ∙ Time poverty as overlooked social determinant ∙ Limited safe spaces and nutritious food access ⚠️ When systemic barriers persist, they jeopardize even intensive interventions and limit sustainability. 💡 EVIDENCE-BASED SOLUTIONS Policies that work: • Earned Income Tax Credit → decreased obesity • WIC → increased fruit/vegetable consumption • Walkable neighborhoods with greenness → lower obesity rates Most successful programs: • Target families in schools/childcare • Include structural changes (not just education) • Leverage social connections and acknowledge time constraints Healthcare actions: • Systematic SDOH screening • Address GLP-1 agonist access disparities (significantly underutilized in non-White/underserved groups) • Connect patients to community resources 🎯 CLINICAL PEARLS 1. Screen for social determinants not just medical risk factors 2. Address weight stigma actively 3. Understand cultural differences in weight perception 4. Advocate for equitable medication access 5. Use telehealth to reduce time/transportation burden 💭 THE BOTTOM LINE Obesity is NOT a personal responsibility issue, it’s a complex condition driven by multilevel socioeconomic and structural factors. We cannot solve a structural problem with individual-level solutions alone.

Honored to contribute to the Forbes conversation on making the business case for health equity. As EY's Chief Medical Officer and Center for Health Equity Leader, I believe that developing a business case that supports health disparity elimination, driven by astute financial modeling is an imperative to achieving health equity. First, we must define prioritized clinical conditions to address for gap closure. Second, we must understand the projected investments in health equity strategy and execution (people, programs, processes etc.). Thirdly, use financial modeling to codify the cost avoidance achieved through prevention, early disease detection, and efficient clinical care coordination in populations at risk for health disparities. Finally, aligning this insight with the required investment provides line of sight towards a realistic ROI related to this work. Let's make health equity an integral pillar of our business strategy. Read the article: https://lnkd.in/dJbFYTcA #HealthEquity #EY #Forbes #BDHEA Sophie O. Susan Garfield Caretha Coleman Deborah D. Phillips John Daniels Jr Regina Benjamin, MD, MBA Joe Wilkins, MBA, FACHE Alfonse Upshaw, NACD.DC

Book introduction series: Valuing Health: The Generalized and Risk-Adjusted Cost-Effectiveness (GRACE) Model #admin Cost-effectiveness analysis (CEA) plays an important role in health policy debates, helping to shape resource allocation and pricing decisions. Yet many economists also recognize that the current framework can offer misleading and incomplete results. Current CEA methods imply that health improvements are equally valuable to those in good health and poor health, which fails to recognize the increased value of health improvements for those with severe illness or disability. Valuing Health introduces the generalized risk-adjusted cost-effectiveness (GRACE) model as a more accurate method for determining the value of medical treatments and technologies. The GRACE model generalizes the underlying CEA assumption of constant gains in health care, demonstrating through diminishing returns the greater economic value of improving the quality of life for individuals with disability or severe illness. Valuing Health also provides sensitivity analyses to show how value measurements change alongside key parameters, including the potential effects of various combinations of risk preferences on the aggregate value of treating a defined population with any set of available treatments. It concludes with a discussion of the ethical differences between the CEA and GRACE methods and outlines steps for implementing the GRACE model to replace standard CEA as the proper method for valuing medical interventions. Valuing Health offers a revelatory reconceptualization of current valuation models in health economics with clear guidance for inclusive pricing and regulation that reflects the true value of modern health care.

“I am going to kill a Black woman today.” 👆. I highly doubt that any doctor, nurse, or midwife wakes up thinking this. And yet, the data tells a different story. 👉. In the U.K., Black women and birthing people are 3 times more likely to die during pregnancy or within six weeks postpartum than White women. Asian women face 1.8 times the risk. 👉. In the U.S., Black women are 3.5 times more likely to die. Indigenous women face 2 to 3 times the risk. 👉. In Nigeria, maternal mortality stands at 576 per 100,000 live births—the fourth highest globally. Each year, 262,000 newborns die at birth, the second highest national toll worldwide. 👉. In Norway, immigrant women—especially from countries like Iraq, Afghanistan, and in particular, Somalia—experience significantly higher rates of adverse maternal outcomes, even in low-risk settings. 👉. Across Europe, perinatal mortality is consistently higher for non-European migrants. This is not just a crisis. It is a pattern. A system functioning exactly as it was designed. So when Astrid Sundberg asked me on a panel (by Operation Smile Norge) what’s needed to shift health equity over the next 5–10 years and who’s responsible, my response was clear: Health Equity Requires More Than Access—It Requires Power Redistribution. 🔺. Four Critical Actions: 1️⃣ . Redesign Healthcare for Equity: Move beyond a one-size-fits-all model. Healthcare must be community-driven, culturally competent, and centered on prevention, not just treatment. Fund solutions co-created with those historically excluded. 2️⃣. Reform Funding & Policy Structures: Shift from short-term, reactive funding to sustained investment in public health, workforce diversity, and the social determinants of health. Policies must dismantle the economic inequities driving health disparities. 3️⃣. Reclaim Data & Narrative Power: Who collects, interprets and controls health data controls who gets prioritized. Decolonize research, center lived experiences, and redefine what "health outcomes" mean on our terms. 4️⃣. Enforce Accountability for Health Justice: Pledges are meaningless without enforcement. Governments, corporations, and institutions must be held to measurable commitments—not performative inclusion, but real shifts in power. ⭕. Who is Responsible? Everyone with power to shape outcomes. 👉. Governments must legislate systemic protections. 👉. The private sector must invest in ethical, inclusive healthcare innovation. 👉. Researchers & medical institutions must challenge biases in care and treatment. 👉. Communities most impacted must not just have a seat at the table—they must set the agenda. The real question isn’t just who is responsible—it’s who is willing to surrender power to create real change? ---- I finally had the honor of sharing the stage with the incredible Ishita Barua, MD PhD—She's absolutely phenomenal. Also on the panel were exceptional practitioners Lumbwe Chola, Jennifer Gilbertson, and Tish Gilbert.

Health inequality is not just about healthcare – it’s about how we choose to organise society. Yesterday, I attended a powerful lecture on Social Justice and Health Equity by Professor Sir Michael Marmot. In The London School of Economics and Political Science (LSE) Health's Annual Lecture, Michael Marmot, Professor of Epidemiology at UCL and Director of the UCL Institute of Health Equity, outlined why the need to reduce inequalities in health is a matter of social justice. Here are some key lessons that stuck with me – and should matter to anyone working in health, policy or social justice: 1. Health inequality is a social justice issue – not just a public health one. → Health outcomes are shaped by the conditions people are born, grow, live, work and age in. 2. The “social gradient” matters – it’s not only about the worst-off vs. everyone else. → Inequalities run through all levels of society and solutions must reflect that. 3. Policies shape health – and austerity harms it. → UK Example: Austerity measures cut public spending from 42% of GDP (2009-10) to 35% (2019-20), hitting the poorest communities hardest. → Life expectancy gains stalled in England in 2011 and declined during the pandemic  – health reflects the state of society. 4. Child poverty is a policy failure. → UK Example: Despite high child poverty rates, government underinvestment continues. → Sure Start centres – vital for families – were shut down, worsening inequalities. 5. Fuel poverty and housing inequality are public health issues. → UK Example: Over 50% of homes need thermal upgrades to reduce cold, damp living conditions. → The UK has some of the worst-insulated homes in Europe, making poverty even harder to escape. 6. The US story shows similar patterns - but worse outcomes. → US Example: The US ranks 29th out of 39 countries for life expectancy. → At every income level, Americans live shorter lives than people in the UK.  → Why? Extreme inequality + low public investment. 7. Cross-sector action is essential. → Health equity isn’t just for healthcare – we need education, housing, urban planning and taxation on board. 8. Hope, dignity and community matter. → Fighting inequality is about restoring belief in a better future – if everyone works together to make a difference. 💥 The takeaway? ✅ Health reflects the state of society. ✅ Inequality is a policy choice. ✅ We can do better – if we choose to. Inequalities are growing. Future generations deserve better. If you’re working in this space – I’d love to hear what gives you hope. ❓How can we – as individuals, communities, businesses and policymakers – act now to close these gaps? ♻️ Please share to help your network and follow Anna Dé for more content. #HealthEquity #SocialJustice #PublicHealth  #FutureGenerations #LSE