The recent announcement that insurance premiums will be going up for people who buy their health coverage through the Affordable Care Act, or “Obamacare,” has put the program back in the news, with Republicans from Donald Trump on down calling for its repeal and Democrats saying its problems can be easily fixed.
But the issue that neither side ever wants to talk about is that the federal law, whether it survives or not, will have little effect on the health of most Americans.
Everyone should have access to health care, and health insurance helps shield people from financial disaster when they get sick or injured. So the Affordable Care Act, if it worked as intended, would be a step in the right direction.
But health insurance alone doesn’t make people healthy, because so much of what determines our health happens outside a doctor’s office. Where and how we live, work and play is far more important.
A groundbreaking poll of Californians released last month may provide the clearest evidence to date of the link between living conditions and health. The survey also shows how health and wealth, ethnicity and geography are all connected.
The poll of 2,200 adults, funded by The California Wellness Foundation and conducted by The Field Research Corp., shows that Californians who say they live in a safe, healthy community are also more likely to report that their own health is good.
Fewer than half of those who rated their community as a healthy place to live also said their own health as “excellent” or “very good.” But nearly two-thirds of those who rated their own community positively also reported that they were healthy.
What kinds of things make a healthy community?
Low crime rates, good jobs, access to public parks and open spaces, clean water, stores that sell healthy, affordable food, and good relations between people of different racial and ethnic backgrounds. The more people report that their neighborhoods have each of these things, the more likely they are to also say that their health is good.
Not surprisingly, these characteristics are more common in wealthier communities than poor ones.
Nearly 9 out of 10 upper income residents describe their community as a “healthy place to live,” while barely more than half of low-income people apply that description to their community. Low-income Californians say their communities are have more crime, more environmental problems, fewer jobs and not as many places for kids to play.
Similar disparities show up when you look at the data across ethnic and geographic lines. Nearly three-fourths of non-Hispanic whites say they live in a healthy community, compared to 67 percent of Asian-Americans, 59 percent of Latinos and 58 percent of African-Americans. And residents of the Southern California coast and the Bay Area are more likely to say they live in a healthy community than people who live in the Central Valley or Los Angeles.
The bottom line is that while it’s important to provide access to insurance and health care, improving the health of all Californians, and all Americans, is going to depend on the far more difficult task of making sure that everyone lives in a clean, safe, and healthy community.
If you think Obamacare is controversial, wait until we try to tackle that one.